The Political Economy of Avian Influenza in Indonesia

Paul Forster


The Political Economy of Avian Influenza in Indonesia
Why is the response to H5N1 highly pathogenic avian influenza (HPAI) so challenged in Indonesia? Why did the virus spread so fast, and why has the disease persisted? Are there features of the country and its culture that encourage or inhibit the disease? Is the internationally led response appropriately sensitive to local contexts? This paper suggests that distinctive social, cultural, economic and political factors work against a technocratic response such as has been employed in Indonesia. The paper explores the interactions between global bio-medicine, a mesh of power relations linking health, industry, institutionalism and governance, and Indonesia’s diverse and complex political and social contexts. How is an infectious zoonotic disease controlled in a dynamic environment where modernist models of authority and rationality are unproven? Since H5N1 was first detected in central Java in mid-2003, it has spread to 31 of Indonesia’s 33 provinces, caused the death or destruction of at least 150 million poultry birds, and killed over 110 humans. The international response, which began in mid-2005, has focused on animal surveillance, control and vaccination, human health system capacity building, and information and behaviour change communications. The response is challenged by the size, geography and infrastructure of the country, an exuberant democracy and extensive decentralization. Other diseases, sectarian tensions and regular natural disasters overshadow the threat of HPAI to human health and food security. Nevertheless, issues of trust between science, government, business and civil society, and nationalism, are shown to be key, as are the varying constructions of risk, public goods and governance associated with the international organizations driving the response, and the people affected by the disease.

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How do we deal with the spread of HIV/AIDS or avian ‘flu? How can farmers in dryland Africa cope with the challenges of climate change? How do we address water and pollution problems in rapidly growing Asian cities? Who benefits from genetically-modified crops? Today’s world is experiencing rapid social, technological and environmental change, yet poverty and inequality are growing. Linking environmental sustainability with poverty reduction and social justice, and making science and technology work for the poor, have become central challenges of our times. The STEPS Centre (Social, Technological and Environmental Pathways to Sustainability) is a new interdisciplinary global research and policy engagement hub that unites development studies with science and technology studies. We aim to develop a new approach to understanding and action on sustainability and development in an era of unprecedented dynamic change. Our pathways approach aims to link new theory with practical solutions that create better livelihoods, health and social justice for poor and marginalised people. The STEPS Centre is based at the Institute of Development Studies and SPRU Science and Technology Policy Research at the University of Sussex, with partners in Africa, Asia and Latin America. We are funded by the ESRC, the UK’s largest funding agency for research and training relating to social and economic issues.

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Paul Forster is an ESRC STEPS Centre doctoral student at the Institute of Development Studies at Sussex University and a member of the STEPS Centre epidemics project. He is based in Jakarta, Indonesia. This is one of a series of Working Papers from the STEPS Centre ISBN 978 1 85864 582 4 © STEPS 2009

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The Political Economy of Avian Influenza in Indonesia

Paul Forster

(2009) The Political Economy of Avian Influenza in Indonesia. or build on this Non-commercial: You may not use this work for commercial purposes. Brighton: STEPS Centre ISBN: 978 1 85864 582 4 First published in 2009 © STEPS 2009 Some rights reserved – see copyright license for details Thanks to Peter Roeder and Ian Scoones who kindly provided peer reviews and to Naomi Vernon and Harriet Le Bris for help with copy-editing.0/legalcode) Attribution: You must attribute the work in the manner specified by the author or licensor. For any reuse or distribution. P. Design by Wave (www. translate or perform this work without written permission subject to the conditions set out in the Creative Commons Barney Haward and Lance STEPS Centre publications are published under a Creative Commons Attribution – Non-Commercial – No Derivative Works 3. No Derivative Works: You may not alter. Brighton BN1 9RE. If you use the work. transfer. STEPS Working Paper you must make clear to others the licence terms of this work.Correct citation: Forster. we ask that you reference the STEPS Centre website (www. University of Sussex.steps-centre. University of Sussex. 2 .steps-centre. Brighton BN1 9RE Tel: +44 (0) 1273 915 673 Email: display. For further information please contact: STEPS Web: www. UK (steps-centre@ids.0 UK: England & Wales Licence (http://creativecommons. Users are welcome to and send a copy of the work or a link to its use online to the following address for our archive: STEPS distribute.

Brighton: STEPS Centre 3 . with partners in Africa. Politics and Policy. I. Brighton: STEPS Centre We would like to acknowledge the support of all these projects and donors. The STEPS Centre (Social. (2009) The Political Economy of Avian Influenza in Indonesia. R. STEPS Working Paper 17. The project has been supported by the FAO ProPoor Livestock Policy Initiative (http://www. STEPS Working Paper Scoones. technological and environmental change.About the STEPS Centre How do we deal with the spread of HIV/AIDS or avian ‘flu? How can farmers in dryland Africa cope with the challenges of climate change? How do we address water and pollution problems in rapidly growing Asian cities? Who benefits from genetically-modified crops? Today’s world is experiencing rapid social. Our pathways approach aims to link new theory with practical solutions that create better livelihoods. Asia and Latin America. We aim to develop a new approach to understanding and action on sustainability and development in an era of unprecedented dynamic change. London with support from DFID and the World Bank. and Forster. P. STEPS Avian Flu project publications (available to download free from www. Brighton: STEPS Centre Safman. yet poverty and inequality are growing.html). Technological and Environmental Pathways to Sustainability) is a new interdisciplinary global research and policy engagement hub that unites development studies with science and technology studies. a core project within the Centre’s epidemics research programme. Brighton: STEPS Centre Forster. STEPS Working Paper 10 Ear. P.html) and the ‘Livestock-sector governance in developing countries’ project coordinated by Chatham House. S. and making science and technology work for the poor. the DFID-funded Pro-Poor Risk Reduction project (http://www. STEPS Working Paper 19. (2009) The Political Economy of Avian Influenza in Thailand. T. We are funded by the ESRC.steps-centre. health and social justice for poor and marginalised people. The STEPS Centre is based at the Institute of Development Studies and SPRU Science and Technology Policy Research at the University of Sussex. (2009) Cambodia’s Victim Zero: Global and National Responses to Highly Pathogenic Avian Influenza.html). the UK’s largest funding agency for research and training relating to social and economic issues. STEPS Working Paper 18. (2009) The Political Economy of Avian Influenza Response and Control in Vietnam.fao.steps-centre. About the STEPS Avian Flu project This paper has been produced as part of the STEPS Centre’s ‘Avian flu: the politics and policy of a global response’ project ( http://www. have become central challenges of our times. Linking environmental sustainability with poverty reduction and social justice. (2008) The International Response to Highly Pathogenic Avian Influenza:

........................................................................................................................................................................37 AGITATING FOR CHANGE..........................................TABLE OF CONTENTS INTRODUCTION ...................................... DANGER AND DIVERSITY .................................................... 5 DEMOGRAPHICS.................................................................................................49 REFERENCES .......................................................................................................................13 THE ARRIVAL OF HIGHLY PATHOGENIC AVIAN INFLUENZA ....................................................................................................................................... 7 POLITICS AND POLICY MAKING ..........................................................................................................................................................................................................................................................................................................................................................................14 ACTORS......................................................53 APPENDIX A: INTERVIEWEES AND RESPONDENTS............................................................................................................................................................... 11 TO 28 AUGUST 2008 ................................65 4 ......................................................................... .........................63 APPENDIX D: ROAD MAP OF KAMPONG CHICKENS IN BALI ............................ NETWORKS AND NARRATIVES ..............................................11 LEGISLATION AND THE RULE OF LAW ..30 HUMANS AT RISK? ....................................................................................... 9 A BIG BANG ......................................................................................................................................................42 VIRUSES AND SOVEREIGNTY ................................. JAKARTA.22 THE RESPONSE: NATIONAL AND INTERNATIONAL NETWORKS AND NARRATIVES ........................................................................................................................................................................46 CONCLUSION ................................................... BOGOR AND MAJALENGKA...................................................................................................................58 APPENDIX B: COMPARATIVE DATA FOR INDONESIA .......................................................................................................64 APPENDIX E: ACTOR NETWORK DIAGRAM ....................................................59 APPENDIX C: LAYER MARKET CHAIN IN NORTH SUMATRA......................................................................................27 CHASING THE CHICKENS ..............................................................................................................


Tek kotek kotek Anak ayam turun sepuluh Mati satu, turun sembilan…
Cheep-cheep, cheep-cheep, cheep-cheep Ten baby chickens run around Then one dies, and nine survive… Popular nursery rhyme heard in Majalengka, West Java, 17 August 2008 to be repeated, counting down… Indonesia is more affected by H5N1 highly pathogenic avian influenza (HPAI) than any country in the world. Since 2003, when it was first detected in central Java, HPAI has spread to 31 out of 33 provinces, caused $470 million in economic losses1, disrupted the livelihoods of over 10 million people who are dependent on the poultry industry2, and killed 113 people out of 139 confirmed human cases, mainly children and young adults3. Indonesia has also received the largest financial commitment to fight avian influenza from the international community, totalling over $128 million4. This has resulted in huge programmes of surveillance, culling, vaccination, and information and behaviour change communications, led largely by United Nations agencies, and some improvements to the health system. Despite these efforts, HPAI remains endemic in Java, Sumatra, Bali and Sulawesi, and sporadic outbreaks continue to be reported in other areas5. Historically, and today, Indonesia experiences economic uncertainty, inadequate infrastructure, and regular natural and unnatural disasters, as well as separatist agitation and intermittent sectarian violence. The size and geography of the country also conspire against an easy response to avian influenza, and complex social, cultural, and political factors are at work. Over half of all households keep poultry at home, and chickens, together with other birds, play an important role in culture and provide the poorest with something to eat and trade. Indonesia is also a numinous culture. Fatalism and humility prevail in the face of threats from the natural world in particular. Despite being an ideal

KOMNAS Presentation, 10th National Veterinary Conference of the Indonesian Medical Association, Bogor, 20 August 2008. 2 accessed 7 November 2008 3 WHO: Avian influenza – situation in Indonesia – update 45 9 December 2008 available at accessed 22 December 2008 4 UNISIC & World Bank (2008) 5 FAO (2008) 5

place for a human influenza pandemic to start, there is little popular conception of such an event, and poor comprehension of its consequences. Understanding policy processes must take such contexts into account. How risks are understood, and how responses are framed, are very much located in particular ecological, social and political contexts, and Indonesia presents its own distinct set. Politically, Indonesia is a dynamic young democracy emerging from 40 years of autocratic rule. Created out of political repression, economic hardship and the triumph of people power, today's political environment might be characterised as a democracy in formation where protest is usually met by political compromise. This makes any robust response to AI politically challenging. At the national level, and at that of 456 autonomous districts and municipalities, there is little trust in government. This is sometimes justified. Despite good intentions, all post-1997 administrations have suffered a degree of continuity with those of the past, which were characterised by institutionalised corruption, opaque processes and collusion with business interests. Then, as now, the government faced numerous distractions, and it has not interacted significantly with either the industrial poultry sector, which is used to being autonomous and self-sufficient, or the millions of small farmers, who are also used to being autonomous and self-sufficient. Trust again is central. Does the government have any great competence? Does it have any right, or rights, to demand action? This complex relationship between the state and its bureaucracy – a vast, decentralised network of local governments and administrations – and the people, be they peasants or industrialists, is central to understanding the policy processes surrounding the emergence of avian influenza in Indonesia, and the responses to it. As this paper shows, the relationship is neither straightforward nor fixed, and has led to a situation that is challenging the ideal plans of the government, its donor supporters, and the implementing agencies. All Indonesian poultry production is consumed by the domestic market and imports are negligible. Chicken is Indonesia’s favourite meat, and around ten conglomerate companies control all industrial production, with three responsible for 70% of the market. Most integrators operate at least partially under sub-contracting schemes that see poultry, material associated with poultry production, and waste products, widely transported about the countryside. Small scale ‘backyard’ and village farmers also make a significant contribution to production, and hobbyists abound. Although both groups are keen to blame the other, the nub of the problem does not lie in industrial farming, or in backyard farming, but in the interactions between them, and the widespread movements of poultry products associated with both. Only now are the results of detailed studies becoming available, with markets and market-related movements becoming more clearly implicated in the spread of the virus. The HPAI response has been led by international agencies, operating in emergency mode. The Food and Agriculture Organization of the United Nations (FAO), working with the Indonesian Ministry of Agriculture, has been in the front line, creating and implementing disease control plans designed, and led, by veterinarians and public health experts. The scale of the problem is awesome, however, and technical, science-led, approaches such as vaccination are proving challenging to implement in village and backyard settings. The need to understand and get involved with critical issues such as compensation for culling, for example, which involves disbursement of small sums of money to large numbers of people, adds huge complexity, some of it political. Communications, led by the United Nations Children’s Fund (UNICEF), and organizations such as Development Alternatives, Inc., have been more fragmented but no less extensive. Very successful in raising awareness, they have affected long lasting attitude or behaviour change less convincingly. The United Nations World Health Organization (WHO) has been faced with the most extreme political difficulties, despite pressing needs for fundamental scientific research and improvements to a lowlevel healthcare system. It has however added important specific capacity.


This international architecture, whilst faced with its own internal challenges of priorities, cultures, coordination and trust, is also charged with co-ordinating and building relations with national, provincial and regional government and non-government agencies, and individuals, as well as civil society, in an atmosphere of charged nationalism and complex politics. Just as the people are suspicious of the government, the government is suspicious of the global community. This leads to a larger question: how will Indonesia – at the epicentre of the global avian influenza epidemic – choose to relate to the rest of the world, which is fearful of the consequences of a human pandemic? Here tough geopolitical debates about equity, public goods and global responsibilities arise, illustrated most starkly in the controversy surrounding virus sharing (see Viruses and sovereignty below). This paper is the result of three weeks fieldwork in Indonesia in August 2008 that involved interviews with 38 individuals6. The majority were professionally involved in the avian influenza response, although a number had broader interests in politics, economics and society. This followed interviews with 59 people involved with avian influenza based in Europe and the US (cf. Scoones and Forster 2008) and a literature review covering avian influenza, agriculture, health, politics, society and economics in Indonesia. This included academic studies, and published and unpublished policy, strategy and evaluation documents produced by national and international bodies. Three transect walks were accomplished in Jakarta, and two in Majalengka, West Java. A press review covering the period 2004 to 2008 provided a wider picture, which was triangulated with data from interviews and the literature. For reasons outlined in the paper, the perspectives of the integrated poultry industry are not well represented, directly, nor those of the Indonesian Ministry of Health. For reasons of time, the concerns and activities of the Association of South East Asian Nations have not been addressed. The paper first outlines the geographical, economic, ecological, cultural, and historical context of Indonesia. A description of political events since 1997 leads to an analysis of the current political situation, in particular the challenges posed by decentralization and the legal system. The late reporting of the initial HPAI outbreak to the World Organization for Animal Health (OIE) is investigated, and a time line contrasts major events related to avian influenza with other, competing, events. The role of poultry in everyday life and commerce is described, and the responses to avian influenza are elucidated through outlines of the roles and activities of the national co-ordinating agency, and related national and international bodies. This is divided in sections covering agriculture, public health and communications. One objective is to identify both dominant, and neglected, actors, networks and narratives (persistent storylines) involved, and their interactions, or the lack of them. Finally Indonesia’s recent refusal to share human H5N1 virus samples is investigated, and some conclusions are offered.

The Republic of Indonesia’s 235 million citizens7 inhabit some 6,000 islands in a 17,508 island archipelago that stretches over 5,000 km between mainland South East Asia and Australia. Ranked 107 out of 177 countries in the UNDP’s 2007/2008 Human Development Index, GDP per capita was $3,471 in 2006 (PPP, current international dollars) with 40% of the population living on less than $2 a day (Asian Development Bank 2008). Despite a slowing global economy, national economic growth reached a ten-year high of 6.3% in 2007 with unemployment falling to 9.1%, exports growing, and the balance of payments account showing a surplus (McLeod 2008:185-186, CEIC Asia database8). Further data for Indonesia is presented in tabular form in Appendix B.
6 7

See Appendix A Nearly every statistic relating to Indonesia needs to be treated with caution. A recent study found a shortfall of 36 million people in the national electoral roll, for example (Jakarta Post 21/8/08). 8 Available at accessed 11 December 2008 7

Wahid was implicated in two corruption scandals. even with SBY consistently leading the opinion polls. and in a state of the nation address on 15 August 199810. quasi-socialist economic policy that resulted in hyperinflation and economic stagnation. An attempted coup in September 1965 was countered by the army and subsequently between 500. timber. but exchange rates still wander alarmingly. and political and economic stabilization became the main tasks of government. natural gas. impeached. which has a remarkably high population density of nearly one thousand people per square kilometre. the first direct presidential elections were held and Susilo Bambang Yudhoyono (known by his initials SBY) won a clear victory in a second round run off against Megawati. amassing a fortune estimated to be several billion dollars (McLeod and MacIntyre 2007). Suharto and his close family also prospered. Indonesian independence was declared in 1945. agriculture currently engages 44% of the working population and services 38%. the country held its first free legislative elections and the People’s Consultative Assembly (MPR) subsequently selected Abdurrahman Wahid as president. and with parliamentary elections scheduled for April 2009. Islam however is often mixed with other cultural and religious influences including animist. but the economic and political situation is widely perceived to be. the country is dominated by the island of Java (the Javanese and the Sundanese from western Java make up over half the Indonesian population). From over 300 ethnic groups speak over 700 languages and dialects. which saw foreign debt rescheduled. Habibie was subsequently sworn in as president. bauxite. This period was characterised by endemic corruption and a nationalist. Home to 12% of the world’s mammals. political prisoners were released. Islam is the dominant religion and Indonesia has the world’s largest Muslim population. and rapid changes in the prices of raw materials and basic commodities make forward planning difficult for 9 http://www.ilo. Under Dutch rule for over 300 years. when he was formally appointed. and Megawati was sworn in as the fifth president. and one of the Netherlands’ richest colonies in the 1800s.000 and one million people were killed as alleged communists and supporters (Cribb 1990). who offered the vice-president position to Megawati Sukarnoputri (Sukarno’s second child and first daughter). 42% (Fabiosa 2005:2). an inflow of aid and investment. controls were lifted on the press. and until 1965 the country was under the authoritarian regime of President Sukarno. Buddhist and Christian.J. at least mutable. 8 . and presidential elections for July. recognised in 1949. In June 1999. and has acted significantly in the struggle against pervasive corruption. SBY’s administration has set a new tone of competence and political accountability. Across the country. and significant economic growth: the proportion living below the poverty line reduced from around 60% in 1970 to around 11% in 1997.Rich in natural resources (including petroleum. the future is looking less predictable than usual. Indonesia’s location on the edges of three tectonic plates makes it the site of 130 active volcanoes and frequent earthquakes and tsunamis. if not in a state of flux. In July 2001. In July 2004. 17% of the birds and more than 25% of all marine and freshwater fish. 22% of the population lived in urban areas and in 2002. In 1980. coal. tin. Hindu. The 1997 Asian economic crisis devastated the economy and provoked dramatic political change. More corrupt and authoritarian than Sukarno. the country is more resilient than it has ever been. 16% of the reptiles and amphibians. copper and fertile soils). Economically. independent political parties and unions were sanctioned. however. B. In what became known as the Reformasi era. President Suharto reversed many of Sukarno’s policies and initiated a ‘New Order’. Adult male literacy is reported at 92% and female at 83%9. Popular discontent and resentment at the government’s corruption manifested in urban riots and Suharto was forced to resign in May 1998. he suggested that the proportion in poverty had soared to 40%11.htm accessed 12 December 2008 10 Jakarta Post 16/8/98 and in Bourchier and Hadiz (2003) 11 Fabiosa et al (2004) report real per capita income dropping from $1000 in 1996 to $205 in 1998. Culturally and economically. Dramatic and far-reaching events have arisen rapidly and with little warning in the past. His vice-president. the regime liberalised. if not growing so dynamically.

or House of Representatives. Politically things have got better – we have a free press for example – but there has been no replacement for that authority. B. the Indonesian president is head of state. Two chambers form the legislative branch. or Regional Representatives Council. we would have seen a completely different reaction12. If Suharto had got the bit of bird flu between his teeth. but significant patches of poverty and extreme contrasts of wealth suggest that it is brighter for some than others. or People’s Consultative Assembly. rather than tomorrow. Perhaps living on a chain of volcanic islands fixes minds on the here and now. but this is not a mind set well suited to the years or even decades of determined and consistent activity required to combat a highly infectious disease entrenched in millions of small animals. The 695-member Majelis Permusyawaratan Rakyat (MPR).business and government alike. the ship lost its rudder. Critics. Others suggest that the democratic transition has been marked by dramatic breakthroughs followed by disillusionment. the picture is brighter now than ever. and chief executive. with Suharto’s hand-picked vice-president. has the authority to amend the constitution and to inaugurate. policy-making and foreign affairs. express disappointment at the slowness of reform. These moves have seen the DPR gain considerable power. It is made up of all 550 members of the Dewan Perwakilan Rakya (DPR). economic hardship and far-reaching political change’. or the day after. and discharge. We are fixing a new rudder now. moving into the presidential palace. however. and that a high degree of continuity exists between the new democratic politics and those of the authoritarian past. suggesting that the DPR has yet to demonstrate any great capacity to distinguish between privately and socially beneficial demands. Politically. and has seen significant change since the beginning of the Reformasi era. Other organs of state include the Supreme Court (Mahkamah Agung). McGibbon (2006:321) characterises the period of 1998 to 2004 as ‘six years of weak government. who are elected for a five-year term by proportional representation in multi-member constituencies. He or she appoints a council of ministers to serve as the executive. Since 1999. but everyone looked to him to steer the ship. but the rudder is not so big. Aspinall’s (2005) analysis sees Suharto’s government replaced by a reconstituted version of itself. and going forwards again. Jakarta 25 August 2008 9 . The questions emerge: How can HPAI be managed in such a setting? Are the existing political processes fit for such a purpose? How might they help or hinder the response? POLITICS AND POLICY MAKING Indonesia’s system of government is both presidential and parliamentary in style. a far-reaching decentralization programme. one interviewee said: An entirely family-orientated country lost its father. and that a dangerous fragility may not be far beneath the surface. the Constitutional Court (Mahkamah Konstitusi) and the State Audit Board (Badan Pemeriksa Keuangan). and remains unresponsive to concerns about the business environment (McLeod and MacIntyre 2007).J. presidents Wahid and Megawati also failed to inspire. and it is increasingly assertive in its oversight of the executive. and the creation of the DPD. responsible for domestic governance. 12 Interview. and forwards movement. plus the members of the Dewan Perwakilan Daerah (DPD). and not so well connected to the helmsman. the president and vice-president. in which each province is represented by four members. His successors. He was not always the kindest father. constitutional and institutional reform has led to some important changes including direct presidential and parliamentary elections. A vague nation became even vaguer. commander-in-chief of the armed forces. two-term limits for the president and vice-president. On Suharto’s demise. Habibie. who need not be elected members of the legislature. also selected at general elections. According to the amended 1945 constitution.

and addressing the issue of deep-rooted corruption. More nuanced comment. Indonesia is accustomed to strong and decisive leadership. and Suharto’s (1967 – 1998) on ‘patrimonial’ authority. This compares with systems involving smaller numbers of parties. such as floods. One example given is the government’s reluctance to confront growing religious intolerance (McLeod 2008:183). a reserved. has been an unwillingness to engage with both the business interests associated with the integrated poultry industry. This paper suggests that another. Sukarno’s presidency (1945 – 1967) was arguably based on ‘charismatic’ authority. Only in the last ten years has the country made moves towards a European (Ancient Greek) idea of democracy. Another factor fomenting against change is the fragmented multi-party political system. Thirdly. SBY. the control room of political order is still under construction. Other successes have included maintaining a peace agreement with secessionist Aceh province. Finer grain analyses of Javanese concepts of power (cf. where support must be cultivated and maintained across a broader range of social groups. 10 . however. which has been described as ‘a triumph of personality. founded on modern concepts of the law. One reason for this inability to defend and push through difficult decisions is that. and powerful mythological ideas such as that of the satria (knight) – the smooth and unruffled man of power who exerts himself as little as possible in any action – are far from irrelevant. In Max Weber’s terms. and so can focus on providing benefits to their own supporters. as symptoms (but not causes) of a lessening of a ruler’s power. First. Under Suharto. A further. and to prefer stability over unsettling political and economic change (McGibbon 2006). deliberation. This may cause particular problems in diverse societies like Indonesia where parties often form around distinct social groups based on ethnic. in the face of a significant number of competing priorities. as the next section outlines. Secondly. and the 30 million or so households which keep poultry at home. He has fostered democracy. SBY does not have a natural constituency. and given the economy a much-needed boost through sound microeconomic policies and structural reforms. manoeuvred the army out of politics. where posts and state resources may need to be distributed to neutralise party opposition. secular and relatively progressive ex-army general from Java. from South Sulawesi.Susilo Bambang Yudhoyono’s 2004 success in the first ever direct presidential elections saw a new optimism. the current president. only three officially sanctioned and tightly controlled ‘national’ parties were allowed. on the country’s northern tip. and 24 in the 2004 elections. consultation) are still very much in play. essential good manners) prohibit any sort of display of agitation. and Megawati’s in secular nationalism. facing the challenges of coaxing politics towards the base of a ‘legal’ authority. the protocols of power (as well as the associated. or at least not acknowledging it as a substantial problem. has been credited with forming a successful partnership with the more exuberant vice-president Jusuf Kalla. a base political instinct must suggest ignoring HPAI. eruptions and plagues. religious or regional identities. Haggard (1997 cited in Reilly 2007) points to the difficulties of such systems in which parties may only need a small plurality of votes to win office. SBY’s touchstone might best be described as pragmatic populism. factor supporting the status quo is the practical complexity of political life in ‘rainbow’ cabinets. image and popular choice over party machine politics and the power of party bosses’ (Aspinall 2005a cited in McGibbon 2006). Traditional Javanese political processes such as musyawarah (discussion. and related. the state and bureaucracy. compared with the two previous presidents. The implications for the response to HPAI are manifold. with SBY. suggests that the defining feature of SBY’s presidency has been a strong tendency to engage in political compromise. The liberalisations of 1998 saw over 100 new parties emerge in months (Reilly 2007). If Wahid’s ideology was founded in traditional Islam. Anderson 2006) see manifestations of disorder in the natural world. and only a complex set of incentives and restraints limited numbers to 48 in the 1999 national elections. or real determination for the future to have a particular shape. with vacillation or back-tracking common in the face of any opposition.

Then we have to convince the local animal health people it’s a good thing. Health Ministry officials often meet with outside experts to formulate plans to fight bird flu. Before we can start operating we have to get buy in from the local leaders and decision makers. Many interviewees suggested that this was the most significant challenge to controlling the disease in the country. but they are rarely implemented. a ‘Big Bang’. We have to persuade them. 32/2004 – and Law No. and why there is still no effective response”13. The responsibility for controlling HPAI falls largely on the autonomous district-level governments. with funding mechanisms put in place to enable regions to fulfil their autonomous functions. and national guidelines are only implemented when local officials think it is necessary and have the funds and local support to do so. made the governors. implementation of which began on 1 January 2001. I guess their attitude is that there is no point to otonomi unless you are autonomous14. And only then can we start doing the real work. but the districts don’t have to take any notice. This was a key element in the reform strategy of the IMF. 22/1999 on Governance – revised by Law No. Change came in three areas: a direct electoral system. hierarchical apparatus that was designed not to meet the needs of the people. why it spread so rapidly. It is a long and challenging set of steps15. Jakarta 13 August 2008 11 . which might only have exacerbated centripetal forces. Their 13 14 Interview. Most significantly. Consequently. To pass responsibility to 440-plus autonomous administrations is absolutely ridiculous. The Ministry of Agriculture can do and say what it wants. district heads and mayors representatives of their constituents rather than appointees of central government. Jakarta 15 August 2008 Interview. in January 2007. but to accord with the strategic interests of central actors and their cronies (Erawan 2007). 25/1999 on Financial Balance between the Central and Local Governments). interviewed by Associated Press: The amount of decentralization here is breathtaking. introduced in 2004. local governments were guaranteed authority and discretion in policy innovation. proposed in 1998. but to the districts and the municipalities. One respondent was explicit: “Decentralization is why avian influenza became established here. and widely considered essential to resolve the regional and ethnic tensions that resulted from Java’s historical hegemony and the policies of Suharto’s ‘New Order’. Another said: In terms of dealing with an animal disease decentralization is a disaster. and the bureaucracy was restructured to emphasise local delivery. and nearly always don’t.A BIG BANG The World Bank (2003:1) calls Indonesia's 1999 decentralization legislation (Law No. corporatist controls. Jakarta 12 August 2008 15 Interview. An informant from an international organization responsible for implementation said: What otonomi means is that we have to negotiate with every district. and co-optation of the legislature. Public services for the entire country were implemented through a long. Indonesia comprised 33 provinces and 456 autonomous local governments of which 363 were districts (regencies) and 93 municipalities (cities) (McLeod 2008:201-202). One of the most centralized countries in the world was being transformed into one of the most decentralized. strict control was exercised to the benefit of the centre through the security apparatus. During that period. The story in the health sector is the same. power was not devolved to the provinces. Padmawati and Nichter (2008:44) quote a WHO epidemiologist in Jakarta.

Examining the health sector in four districts (Central Java. and deepening democracy and the emergence of effective government in others. and that elected executives were being forced to take account of citizens’ demands as never before. which under New Order rule was concentrated in Jakarta. Jakarta 11 & 12 August 2008 19 Interview. veterinary services became an ‘easy target’ for cost cutting (Normile 2007:31). such as Agriculture and Marine Service. Yogyakarta and East Java in ‘a replication ad infinitum of the predatory pattern of state-business relations. is that accessed 3 November 2008 17 Interview. conspires against almost every principle of stamping out an infectious animal disease. however. One significant factor is that income per capita is more than 50 times higher in the richest districts compared with the poorest. This requires comprehensive. Hadiz and Robison (2005:234-235) suggest that there are powerful interests intent on maintaining the status quo. but in the district level we cannot always find the Livestock Service since sometimes the Livestock Service is under another Service supervision. especially in its highly variegated and in many senses admirable Indonesian form. The bottom line. and is also sensitively related to the budget issues. Kristiansen and Santoso (2006:254) found no figures available for the real district government expenditure and concluded that ‘there is a total lack of financial transparency and accountability in all districts’. McGibbon (2006:331-2) found that over 40% of incumbents lost office.wordpress. that elections introduced an element of downward accountability. and reward regions that were responding well. Similarly. but also a means to reduce central government expenditure. and they are doing sensible things like paying compensation [for culling] and worrying about reclaiming the funds afterwards”19.power extends to the walls of their office. Otonomi was however not just a political ideology and a reaction to inefficient and corrupt central bureaucrats. Similarly there are variations in the HPAI response and some “pockets of excellence”17. where local officials then decide whether to take action. mainly due to earnings from oil and gas resources. Jakarta 13 August 2008 18 Interviews. In particular. Lombok. there are some proper movement controls. consistent and co-ordinated action across 16 Ketutsutawijaya: available at http://ketutsutawijaya. Concerning elections to the JPPR. Erawan (2007) reports significant variations in the style of politics across the country. Animal Health is a further sub-service of the Livestock service]. The Livestock service is positioned as sub-service [and beyond this. Kalimantan and Flores). with local governments raising taxes from their own natural resources and business activities. and district authorities are not obliged to report accounts. and regions in Kalimantan. the others might get the message and we could see a different picture emerging”20. Other analyses are more positive. covering 224 regions. One interviewee suggested taking advantage of this: “If we could bypass the complex politics at the top. Furthermore. reporting on the rise of gangsters (preman) in North Sumatra. As might be expected – or even hoped – the results of decentralization are far from uniform. but is now growing more or less autonomously at the local level’. As one source16 put it: At the provincial level we can find the Livestock Service. which have only had sporadic outbreaks. are also deemed to have had some successes18. Lampung in Sumatra is often given as an example. with local state capture and rampant corruption in some jurisdictions. and South Sulawesi is often cited as a bright spot: “The governor is engaged. The advice must reach nearly 450 districts. the central state has no mandate to audit local governments. This causes trouble in receiving and applying commands from the centre to eradicate AI. Jakarta 12 August 2008 12 . Bali has been well co-ordinated since mid-2006. Jakarta 13 August 2008 20 Interview.

The situation is further complicated by politics. the government does not actually have the legal capability to cull infected poultry21. As an interviewee put it: “Neither the national government nor the regions have the capacity to address the gaps in the animal health laws. but he tends to body swerve. A respondent said: There is actually no permanent CVO [Chief Veterinary Officer] at the moment. Within the agriculture department itself. Jakarta 11 August 2008 13 . the consequences for the HPAI response are stark.the whole infected area. the co-ordinating minister. is respected. the big food producers – and I don’t think anybody would envy his job in the bird flu response: trying to change the national way of life. of course. But with priorities. avian influenza is just a little rattle deep in the Indonesian machine. They don’t have the skills. No one takes it seriously25. What can you do if there is no law?”24 Another suggested: [Minister] Apriyantono’s appointment was seen as sop to the Islamicists. 6 on Animal Husbandry and Veterinary Hygiene) and does not cover an outbreak situation. matters are no less complex with the Directorate of Animal Health subordinate to the Directorate General of Livestock Services. This should have the highest priority. A revision (provisionally entitled the 2008 Law on Animal Husbandry and Animal Health) has been in draft for over a year. Jakarta 11 August 2008 25 Interview. Decentralization. and it’s hard to blame him. If you look at all the other issues. Who knows what’s really going on. which doesn’t do much for Indonesia. but to my best knowledge the previous CVO. Critics find over 20 shortcomings including: lack of clarity in to whom or to what the Law applies. Running Indonesia’s animal health service is beginning to look like a poisoned chalice26. they don’t have the focus. some of which are prepared to collaborate with their neighbours – and the centre – and others less so. Devising and implementing a national response consistent with the modernist command and control principles of the international guidelines is an uphill task. He spends his time building networks with places like Sudan. was caught up in a scandal. LEGISLATION AND THE RULE OF LAW Indonesia’s legislation relating to animal health dates from 1967 (Law No. 13 August 2008 23 Interview. Jakarta. lack of specificity in defining which diseases are notifiable and what the responsibilities of the veterinary authority are. In theory. and numerically and politically outnumbered by it. Jakarta 11 August 2008 Interview. Bakrie. legislation solves the problem. but as the following section explains. and could get a lot done. According to one informant. they don’t see it as a priority”23. and an inadequate definition of epidemic diseases of livestock22. 21 22 Interview. middle holders. People try to pull him in. funding and even administrative cultures and languages varying across 450-plus autonomous regions. An informant offered one explanation: “The agriculture minister does not have the necessary influence at the high table. Musni [Suatmodjo]. but still has serious flaws. this corner of the control room is in particular disarray. It’s not really part of the national debate. But to be fair to him he has a complex constituency – smallholders. competencies. complicates matters further. He’s not particularly respected. Jakarta 28 August 2008 26 Interview. What do you do except make yourself unpopular? And he has plenty else to do. and the director before that didn’t last long. Jakarta 11 August 2008 24 Interview.

Indonesia was ranked 143 out of 180 countries in Transparency International’s Corruption Perceptions Index for 2007. Yogyakarta (6). have seen large reductions in disease incidence. The following section looks at what happened when the H5N1 virus first appeared in the country. which assumes a Weberian bureaucracy operating in the context of a liberal democracy. Lampung (3). given that there is no reason why the country should follow Europe’s political evolution. Under Suharto. Papua. and some academics and intellectuals. that overall incidence and geographic spread is decreasing. that despite this progress in reducing the level and extent of virus circulation. quoting FAO Chief Veterinary Officer Joseph Domenech: ‘Despite major control efforts. It is true though. and certainly no reason why it should be pressurised to do so. and indeed the SBY’s reputation as ‘Mr Clean’. On the island of Java alone. save for isolated pockets of liberals in a few government ministries and agencies. 27 of 33 provinces were affected (Sedyaningsih et al 2007:522) and at mid-2008. Banten (1). and may be counter productive. enforcement would still be problematic27. science-led approach of the tried and tested international response to infectious animal disease. and more importantly. Consequently.fao. Sumatra. In 2005. such as Bali. Jakarta Post 26/1/04. the rationalist. for example. One question that arises is: is Indonesia likely to attain this state. runs aground on Indonesia’s complex democracy in formation. the disease is not yet under control in 27 28 Ulfah (2008) reports 41 protected species being traded in 17 markets in and around Bogor. In March 2008. the recent high-profile investigations and prosecutions have failed to reach the entrenched interests at the centre of power (McGibbon 2006:325). South Kalimantan (1). Accepting that such responses may usefully bear modification opens up fresh perspectives on understanding what is not possible. Kalimantan and southern Sumatra28. Hadiz and Robison (2005:237-8) conclude: This regulatory state. requires a social and political base which as yet does not exist in Indonesia… In the present with sporadic outbreaks reported from other areas’. such as Kalimantan. over 10 million birds are estimated to have died of the disease since October 2003. Despite a determined anti-corruption drive. At the end of June 2006. the building blocks for such a vehicle are virtually nowhere to be found. all but two – North Maluku and Gorontalo – had reported outbreaks. West Java (3). with 17 afflicted regencies. the country has not succeeded in containing the spread of avian influenza in poultry’29. North Sumatra. or worthwhile. East Kalimantan (1). and if so when? Another. East Java (13 regencies). 29 ‘Bird flu situation in Indonesia critical’ FAO News 18 March 2008 available at http://www. According to the Ministry of Agriculture. Reports from the field in December 2008 paint a more positive picture: Control has been achieved in some areas. consistent with the politics of compromise.html accessed 3 December 2008 14 . and that selected areas. is whether the international response to HPAI needs to be modified to take account of the specific local context. and in September (FAO 2008:49) the official verdict was that ‘the disease remains endemic in Java. incoherent and not under the control of a central force (McLeod and MacIntyre 2007:3). what is. and Ministry of Agriculture data appear to show that the disease is no longer spreading to new areas. Others go further claiming that reformasi era corruption is actually more damaging because it is fragmented. and Central Kalimantan (1). Bali (5). THE ARRIVAL OF HIGHLY PATHOGENIC AVIAN INFLUENZA HPAI first appeared in Pekalongan in Central Java in August 2003 and by January 2004 it had spread across Java and into Bali. it reached Sulawesi. the FAO described the avian influenza situation in Indonesia as ‘critical’. like all modes of organising power.Even if appropriate regulations existed. Bali and South Sulawesi. and in 2006. the provinces hit hardest by the disease in 2003 were: Central Java. Imposing standard rational-technocratic policy solutions on contexts they don’t fit is frustrating. the judiciary was effectively an instrument of the regime and some suggest that. and Aceh.

One informant said: “The rumours say it was industry first. Jakarta 27 November 2008 33 Interview. and there is a need for continued effort30. Ministry of Agriculture presentation.000 chickens reportedly died of the disease in 17 of Central Java’s 35 regencies34. recorded monthly poultry deaths were 530. 22 December 2008 Source: WHO http://www. such as western and Central Java. An Indicative Outline. Rome. Thirty-second Session.5 million birds were reportedly lost in 2004 due to disease and culling35. the Minister of Agriculture issued decree no: 96/Kpts/PD. The Indonesian government declared HPAI infection to the OIE in January 2004 and on 3 February 2004. Jakarta 13 August 2008 34 Jakarta Post 4/10/04 35 Avian Influenza Control Campaign 2006 .id/avian/map/humans_and_poultry. declaring avian influenza a dangerous disease. but that is all there is to go on. Between August 2003 and January 2004. the combined effect of 50% to 60% lower prices and 40% lower sales volumes meant income reductions of 70% to 80% for traders. at least 600. and during peaks of infection in February/March 2005 and 2006. According to the 30 31 Review comment. Thailand has also been suggested as the immediate source of infected birds32. 30 October – 4 November 2006 15 . Phylogenetic analysis suggests that the Indonesian outbreak originated from a single introduction (Smith et al 2006).832 respectively36 with losses due to disease or culling estimated to be between 15% and 20% of all poultry stock. Scientific Conference on Vaccination Verona Italy 20 . The rapid spread is most commonly explained as a result of the movement of infected commodities including commercial chickens (Thornton 2007). resulting from imports of live birds as breeding stock from China (Sedyaningsih et al 2007:522. Others close to the matter say it is essentially unknown in which sector the disease first appeared.2008. Vanzetti 2007:2-3).or.who. Location of Human H5N1 Avian Influenza Cases and Animal Outbreaks at 10 December 200831 Initial outbreaks are thought to have been in the commercial poultry sector.453 and 647. December 2005:6 36 Presentation: ‘HPAI Vaccination Program in Indonesia’. Ministry of Agriculture. Rumour and hearsay”33.22 March 2007 37 Committee on World Food Security.620/2/2004. In 2004. Some 10. and employment opportunities dropped by 40% on larger poultry farms37.gif accessed 26 December 2008 32 Interview. and where it came from.densely populated areas.

however. Similar stories make China the protagonist. or how to do it. there was no reason to think of it as an AI outbreak. At a press conference. Chickens die of disease regularly42 and with no AI reported in the country. viral disease of poultry that does not transmit to humans. We have been asking for the vaccine since September.95 billion) were affected38. describing an illness that th destroyed poultry and devastated the human population in the Maluku islands in the 16 century. Confirmation of millions of HPAI deaths by the East Java chapter of the Indonesian Association of Veterinarians was significant.’ was the response of the Indonesian Poultry Breeders Association 41. one of the most common is that the US introduced the virus to destroy the Indonesian poultry industry and promote its own poultry exports and vaccines. The Chinese government had set a precedent for opacity in their early cover up of the 2002-2003 SARS outbreak. or even the regional bosses. More strategic analyses suggest that it was introduced by the US as part of a global plot to 38 39 Jakarta Post 27/01/04 ‘Govt confirms bird flu after long cover-up’ Jakarta Post 26/01/04 40 ‘S'pore. ‘The government is slow in handling the problem and is giving opportunities for the virus to spread to other areas in the archipelago. Jakarta 13 August 2008 45 Interview. it was easy for the Newcastle43 lobby to influence the decision makers44.Rumours and conspiracy stories A cloud of rumour and some vivid conspiracy stories have emerged around the uncertain knowledge associated with the arrival of HPAI. 44 Interview. as was the Malaysian and Singaporean governments’ ban on poultry imports from Indonesia40. Jakarta 14 August 2008 16 . including the press39. denied allegations that the announcement had been delayed due to pressure from the poultry industry. It’s possible too that the technical people. and the Indonesian government had doubtlessly been pushed to make an announcement. Secondly there was no idea what to do. Many groups.chairman of the Indonesian Poultry Breeders Association. and suggested that the disease had been intentionally introduced into Indonesia by foreign parties. the then Director General for the Development of Animal Husbandry. Sofjan Sudardjat. and with no scientific proof. KL freeze poultry plans’ Jakarta Post 24/01/2004 41 Jakarta Post 27/01/04 42 The Jakarta Post (6/06/2002) reports an outbreak of Marek’s disease killing 2. Industry was unsympathetic. 2. were not aware of the need to report. Box 1 . Senanayake and Baker (2007) offer an intriguing historical perspective. and deadly. but those close to the matter have a more consistent and prosaic set of explanations. very hierarchical. with the government complicit as they would collect higher import taxes. Another said: It was a cock-up rather than a conspiracy. again looking to boost exports. Reflecting nationalist concerns. You have to be deferential.5 million workers in an industry with an annual turnover of Rp50 trillion (US$5.8 million chickens in West Java in early 2002. bureaucratic inertia and incompetence rather than anything deliberate. The civil service here is very formalised. 43 Newcastle disease is a common. One respondent suggested: First there was the matter of not believing it was HPAI. were quick to cry foul. There were no reagents stored for testing. he or she probably didn’t show it to their boss for fear of upsetting them. If there was some technician with a test that was showing positive. A number of vivid conspiracy stories (see Box 1) surround the first months of infection. Doing nothing is always the best course45.

and the increasing scale and scope of the response. One intention is to make clear the scale and frequency of the other deadly and life-threatening occurrences that occupy the media. In June that year. and injured over 100. become evident. They are a more visible target and have no way of putting their case in an organized way. the escalating nature of the HPAI epidemic. Domestic plots suggest that avian influenza was introduced by big business in league with central government to drive small producers out of the market by depressing prices and making factory-raised chickens appear safer3. leave us alone. hold that the government is exaggerating the problem in order to attract donor funds. free presidential election with a 70% turn out. Others. or more specifically to weaken Indonesia. other factors came into play. the people and the politicians did have other priorities. against other newsworthy events. as the virus was spreading rapidly across the most populated areas of the country.indonesiamatters. interest the population. and all manner of other natural and man-made disasters. In September a terrorist bomb in Jakarta killed nine people. As one interviewee explained: Ministers travel all the time. but it is more likely that they see it as their business and their business alone. everything else dropped off the radar. including some poultry farmers. A time line follows setting the significant reported events of the HPAI outbreak. would anybody say thank you to them? Would they get any help? No. They’d be told it’s their problem. Another suggested: We don’t know exactly what happened. Jakarta 26 August 2008 Interview. It might be the case that the industry simply does not want to ‘fess up. Jakarta 25 August 2008 48 Interview. And on 26 December. and the subsequent response. The human death toll from avian influenza – 113 confirmed to date – for example. Whenever it was that some brave soul had summoned up the courage to go to the boss and say ‘we have a problem’ there was a 50/50 chance the boss was away and nobody wanted to know46.destabilise Islamic (accessed 1 November 2008) 3 Padmawati and Nichter 2008:42 4 ibid:38 Once the news reached Jakarta. to make it more dependent on international aid and loans. Evidence given in support of this view is the fact that the disease arrived later in the predominantly Christian provinces2. the country had its first ever. and demand the politicians’ attention. and exuberant. This was understandable”48. the Indian Ocean tsunami hit. Jakarta 14 August 2008 See: http://www. 1 2 Interviews. Many are of the opinion that avian flu is being sensationalised by the press to sell papers4. and therefore behoven to the western powers in need of its natural resources1. And the fact is that in 2004. Secondly. slips towards insignificance when compared with the death tolls from other diseases. If they went to the government. They are expected to and whilst they are away nothing gets delegated. The opinion is that it started in the integrated sector but the backyard farmers got blamed. Timeline – Avian influenza & other events 2004 – 2008 46 47 Interview. we have more important things to think about47. Jakarta 15 August 2008 17 . go sort it out. As one informant put it: “After the tsunami. nothing gets decided. It’s easy to argue that poor and uneducated people are the source of the disease rather than big business.

29/1 Jakarta chicken sales drop 50%. 6/2 First cull: Tabanan regency on Bali.000 Indonesians are dead or missing following the Indian Ocean tsunami. 30/1 Pressure from WHO.4 million chickens. 5/7 First-ever direct presidential elections: former general Susilo Bambang Yudhoyono and incumbent Megawati Sukarnoputri clear front runners.9 million) for compensation and orders the vaccination of healthy chickens. 4/10 HPAI in Grobogan regency. Breeders receive 300.7 trillion ($911 million). pigeons and other birds are estimated to have died from the disease. 7/2 Worries over uncertified vaccines from China reported. 11/4 58. Vaccines to be imported. Other Events and H5N1 Human Deaths 5/2 Earthquake in Papua kills 23. 16/7 7. 5/2 Government announces outbreaks in 51 regencies in 10 provinces across the country with 4. In 2004. Q2 19/6 Officials burn avian influenza Q3 vaccine smuggled from China.000 free doses of vaccine. Selective cull of infected chickens announced. before spreading to other areas. 26/12 More than 200. 3/7 Thailand bans poultry from Vietnam and Indonesia. ducks. 20/10 Susilo Bambang Yudhoyono sworn in as president.000 birds. 13/12 HPAI breaks out in several parts of West Nusa Tenggara. 19/2 Dengue fever outbreak has killed 91 people to date. 2/2 Government allocates Rp50 billion ($5. many of them on Nias island. 26/1 Ministry of Agriculture admits the disease was first spotted in August 2003 in Pekalongan.7M earthquake off Sumatra kills at least 1. 2005 4/3 HPAI spreads to West Java with Q1 Cirebon municipality having the largest number of reported cases. 6/9 Car bomb outside the Australian embassy in Jakarta kills nine people and injures over 100.7 million chickens killed to date at a cost to industry of Rp7. Local officials say that more than 20. more than 10 areas in the province were affected: 1. 28/3 8. . or 25% of chickens died. 20/9 Susilo Bambang Yudhoyono wins 61% of the vote in the runoff round of the presidential election. Central Java. Central Q4 Java.Avian Influenza 2004 24/1 Singapore and Malaysia postpone Q1 poultry import plans following thousands of chicken deaths in East Java and Bali. geese.6 million.301 dengue fever and DHF cases with 658 deaths reported in 2004.000 people. or 43% of the poultry population in the city have died. 18 5/4 Parliamentary and local elections.

) 1/10 Fuel prices double. which has spread to 22 of 33 provinces. 25/7 Director General for Animal Q3 Husbandry announces that the Ministry had distributed 126 million doses of vaccine. 25/7 Cull in Tangerang sees only 31 pigs and 40 ducks destroyed due to lack of compensation money. Government sets aside Rp750 million ($83. . 9/11 Latest data from the ministry shows that as many as 16.000 from chronic TB announced.000 boxes of Tamiflu available. 1/9 ‘Tanggap Flu Burung’ public Q4 awareness campaign launched.000 chickens in four regencies. 2006 27/2 Door-to-door checks and Q1 vaccination in Jakarta after two residents die in January. 5/10 Indonesia currently has 25.2 million birds have been killed due to the virus. (This followed an attack in October 2002 which killed 202. 1/10 Three suicide bombings on Bali kill 20 people. 15/8 Government and Free Aceh Movement separatists sign a peace deal. 25/7 Government designates 44 specialist influenza hospitals across the country. Q2 June Launch of direct elections for local governments.24/3 HPAI continues to spread in South Sulawesi. 10/3 28 confirmed human cases to date of which 21 were fatal. 16/9 Second laboratory confirmed H5N1 human death announced. Government declares “an extraordinary event”. 17/3 Government appoints state pharmaceutical company Indofarma to supply 12 million Osletamivir tablets. 7/3 KOMNAS FBPI created. 19 6/2 Four further human cases announced. affecting around 128. 24/11 Infected birds have been found in seven of 20 subdistricts in Jakarta. 5/9 Passenger aircraft crash in Medan kills more than 150. 8/10 Ministry of Agriculture allegedly complicit with vaccine producers in lowering quality in order to gain more profit from the contract value. 21/9 Ragunan Zoo in South Jakarta is closed: 19 of its captive birds had avian influenza. Indonesia third behind China and India in TB prevalence. 30/3 Over 23 million doses of bird flu vaccine prepared to prevent spread in Central Java. 29/3 Annual death toll of 140. 12/10 Ragunan Zoo re-opens. 2/12 Avian influenza detected in Aceh.333) to assist poultry breeders. Also alleged corruption in the disbursement of compensation funds for poultry farmers. 21/7 First laboratory confirmed H5N1 human death announced. 8/6 Eight new polio cases confirmed bringing total to 28. 8/8 Demand for chicken and eggs increases driven largely by restaurants and supermarkets.

14/4 60th World Health Assembly. 1/4 Participatory Disease Surveillance Q2 programme covers 12 districts in Java. At least 461 killed. 28/5 Mudflow in Sidoarjo. 11/4 Vaccine shortage hampers government's nationwide poultry vaccination drive. 15/9 Bogor begins mass vaccination. slaughtering facilities to be moved. breeding. storage.5 metres from all houses in areas that receive direct sunlight. 25/1 Mass culling blamed for rising prices in Yogyakarta.24/3 Jakarta residents asked to keep their birds in cages.000 people. FAO and UNICEF expert meeting. 6. 8/2 Government appoints Swiss-based Baxter Healthcare SA to develop a human vaccine for the Indonesian strain of bird flu. 16/2 WHO officials meet health minister Siti Fadillah Supari. 7/3 Passenger aircraft crash at Yogyakarta kills 22.7M undersea earthquake off Java kills more than 500 people.000+ ‘infected’ poultry culled to date.3M earthquake kills c.000 people near Yogyakarta in central Java. Indonesia insists on a material transfer agreement. 27/5 6.1b loss and damage estimated.1 trillion ($1. 20/11 President Yudhoyono meets with President Bush in Bogor. East Java. 29/3 Health ministers from 18 AsiaPacific countries issue the ‘Jakarta Declaration’. Q3 20/9 North Sumatra Animal Husbandry Office says five regions in the province are still experiencing worrying levels of poultry deaths. Total is now 96 confirmed cases with 76 deaths. 22/1 Thousands of birds culled in Jakarta. 1/1 Passenger aircraft crash off Sulawesi kills all 102 onboard. displaces more than 10. 2/12 Rp1. 29/12 Ferry sinks in Java Sea. 2/2 Jakarta inspections called off due to torrential rain. . 100. Health authorities ask 30 people to quarantine themselves. North Sumatra. WHO. Geneva. $3.2 million) losses Q4 due to avian influenza announced. 8/2 Floods in Jakarta kill more than 20 and leave hundreds of thousands homeless. 16/4 WHO confirms 15 additional cases. 21-23/6 Government. 30/5 The Ministry of Agriculture 20 18-23/5 Six family members die in Karo Regency. calling for “more open virus and information sharing and accessibility to avian influenza and other potential pandemic influenza vaccines for developing countries”. 7/4 West Java decrees that all poultry Q2 must be kept at least 2. 50% drop in chicken sales reported in Jakarta. including 13 deaths. Poultry health certification scheme announced. 17/7 7. 2007 17/1 Jakarta governor Sutiyoso bans Q1 backyard birds.

27/1 Former President Suharto dies. 15/6 New animal health law proposed to replace the existing 1967 law. there is a continuing and detailed discourse relating to poultry vaccine. If he doesn’t see any chickens on the streets. Thirdly. 23/5 Fuel prices increased by 29% on average with subsidies to 19. 30/1 Three more deaths. from China and 5 million from the World Bank. consumers are quick to abandon poultry products when an outbreak is announced. First is the apparently reactive nature of nearly all of the government’s announcements and actions. whilst there is doubtlessly a media bias towards the capital. and grants of 33 million doses.embassyofindonesia. 26/4 Pandemic exercise on Bali. WHO (http://www. and almost as quick to return to them when the fuss dies down.htm). Jakarta Post (www. it appears to be there that policy is most rigorously implemented. 11/9 International avian influenza conference on Bali. Sources: BBC Online (www. 20/6 Health Minister decides to withhold information on human deaths. and where he drives about. Fourthly. Wikipedia (http://www. where he lives. 25/3 Jakarta administration and KOMNAS announce intensification of prevention and control programme.gimonca. 9/12 Total 139 confirmed cases to date with 113 deaths. and if there are no deaths in the city.or. 23/8 First death on Bali 22/2 Indonesia sent two virus samples to WHO after receiving assurances its rights to any vaccines produced from them would be recognized. both as a solution and a problem.wikipedia. Secondly. Washington DC (http://www. Jakarta 28 August 2008 21 . a number of salient points can be drawn from it. This is probably related to the perception of vaccine as a panacea. his interest level is not going to be that high” Jakarta. HPAI doubtlessly has had a significant impact right through the food supply Sejarah Indonesia (www.thejakartapost. 2008 4/2 An announcement of infections in Q1 chickens causes panic among residents in Banjarnegara regency Central Java. and 66 other airlines from EU air space. Q4 11/7 European Union bans Indonesia's national air 27/8 Jembrana Regency.shtml). with 29 reported cases and 25 deaths. However. and there is little evidence of any determination at the highest levels to drive policies through. Although the disease is not transmitted to humans through properly cooked meat or eggs. 20/11 Follow-up to May 2007 World Q4 Health Assembly meeting. once formed.announces the purchase of 60 million doses of vaccine. Indonesian Embassy. Bali lifts its ban Q3 on chicken meat and day-old chicks from entering the regency following protests from Bali poultry farmers. 28/4 US NAMRU 2 laboratory in Jakarta Q2 accused of engaging in intelligence Some caution is therefore appropriate in any analysis. An interviewee supported this view: “The capital is what the president million poor families.php) The selection of items for inclusion in this time line is from an extensive catalogue and to a degree opportunistic. to the significant business interests 49 Interview. Jakarta has been hardest hit by bird flu.who.

Moslems. together with live bird markets. are all culturally located and highly variable. which is ethnically and culturally diverse. The majority of the population are descended from Austronesian-speaking peoples (originally from Taiwan). responsibility. and remain.associated with providing vaccine on such a large scale. Hindus. The commercial poultry (ayam negeri) sector is large and well organized. Chinese. Negative images are simply not understood because chickens have been a part of life for as long as everyone can remember. Historically.htm accessed 5 December 2008 22 . NETWORKS AND NARRATIVES Some 30 million homes. and post crisis the growth trend 50 51 Interview. On Bali.htm accessed 5 December 2008 53 US Library of Congress http://countrystudies. which can be sold to pay for items such as school uniforms and medical bills (Padmawati and Nichter 2008). and foraging chickens are a common way for poor people to earn additional income and secure food. especially those from Java. ACTORS. authority. Against the background of these relatively high profile reported events. Arabic. totally isolated. with just over half the population. which occur and practically every aspect of life and the world. they are pride. as well as to disease. As well as food and money. the Sundanese and the Balinese – have a strong affection for poultry and other birds. animists and a wide range of syncretic combinations co-exist53. Beyond money and food. employing over one million people (Padmawati and Nichter 2008:32). and the response.embassyofindonesia. networks and narratives has emerged as involved with the HPAI epidemic. Finally. ayam daging) and the meat has about twice the market value: $3 per kilogram compared with $1. many Indonesians – particularly the Javanese. and in terms of religion. Whilst this picture holds true for much of Java. prestige.50 (ibid). Attitudes towards birds and poultry. One respondent stressed that they were not pets: “They don’t have names and usually end up in the pot”50. Poultry hobbyists. more than 300 ethnic groups speak over 700 languages and dialects. Others spoke of a sense of “completeness” they add to a household: Indonesians. love to hear the rooster crowing in the morning. the minister of health’s role in challenging the international status quo with respect to sharing human virus samples gains increasing attention. and to nationalistic complexities associated with the provision of a supply domestically. and European genes and cultural influences have washed through many parts of the archipelago for centuries52. compared with importing it from countries such as China. pigeon-racers. 60% of all Indonesian households. a more complex set of actors. Malay. and Indian. Ayam kampung eggs and meat are considered superior to that of commercial broiler chicken (ayam potongan. A cultural concept exists for the way that birds are kept that is not captured by either the ‘pet’ or ‘livestock’ concepts of the West. but Melanesians dominate in the eastern parts. Wild fowl were probably first domesticated in South East Asia. Other areas have been. This poses a further set of challenges to a uniform and consistent response to HPAI. production rose at an average rate of 15% per annum from 1989 to the start of the economic crisis in 1997. These are outlined in the following sections. In all. chicken and ducks play important roles in religious ceremonies. Jakarta 25 August 2008 52 http://www. the same cannot be confidently said of the rest of the country. Buddhists. are estimated to keep around 300 million chickens (ayam kampung) and/or ducks (bebek) and quail (burung puyu) in their backyards (Normile 2007:31). even Backyard poultry also act as a form of capital. and song-bird and fighting-cock owners abound. Jakarta 26 August 2008 Interview.

PT. 23 . In Indonesia this ratio is usually above 90% (Kristiansen 2007:60). especially for small producers. Manggis. divided into 68% broilers. Medion in Bandung58. imports of soybeans and corn quadrupled with the expansion of the poultry industry between 1991 and 1996. IPB Shigeta Animal Pharmaceuticals. imports came mostly from the US (83. and PT. Poultry production in 1998. The policy was very successful. a drop due to falling demand and the sector’s links to the exchange rate through imported feedstuff ingredients. PT. Now Indonesia imports over one million tons a year of each of the major feed ingredients. As part of general deregulation of the economy. Japfa Comfeed. Charoen Pokphand Indonesia. Simmons (2006:437) suggests total poultry numbers of just under two billion. Indonesia now produces more poultry on less land to feed more people than any other place on earth56. One objective was to spread business and employment opportunities. net profit jumped 129% from Rp175 billion to Rp401 The industry is strongly concentrated in Java and the largest companies are very profitable55. Kristiansen (2007:60) suggests that elements are owned by ethnic Chinese Indonesians with close connections to the family of the former president. government support was largely abandoned in the late 1980s. was less than half the 605kt produced in 1996. Brazil and Thailand (8% each). the largest feed and processed chicken meat producer. PT. Cipendawa Agroindustri. As well as being profitable. a ban on imports of poultry parts and strict inspection and ‘halal’ certification requirements (Fabiosa et al 2004). Encouraging domestic production and promoting rural employment has resulted in the need to import feed and other inputs (Fabiosa et al 2004). PT. The leading companies are parts of complex business conglomerates. the poultry business is considered risky. Wonokoyo Rojokoyo.recommenced54. The industry has grown rapidly because of increasing domestic demand. Japan. the worst year of the economic crisis. and in the early 1980s. Even 54 55 http://www. Vaksindo. In the government’s first Five Year Plan (1969-74) high priority was given to increasing poultry production as a means to provide protein for an increasing population. PT. equipment and drugs). Arguments for this approach have included easier access to veterinary and technical services (Ritter 1984). Japfa Comfeed. 22% native chickens. and most vaccine is supplied by one company. the government passed a decree that regulated the size of commercial laying farms to 5. Cheil Jedang. and PT. and another was to limit the spread of disease in poorly managed large-scale poultry units (Kristiansen 2007). In the first nine months of the year. From a low base in the 1980s. Sierad Produce57. Jakarta Post 13/2/04 58 The two other vaccine producers are PT. Most breeds for chicken egg production in Java and Bali come from one hatchery. egg distribution.98 trillion in sales.japfacomfeed. other activities in these conglomerates include poultry shops (providing feed. In 2000. Protection for the rice industry is also supported by all major political parties (Fane and Warr 2007). and 2% ducks. Feed costs in Indonesia are consequently higher than elsewhere.04 billion) and net profit at Rp450 billion. The ‘big five’ integrators are PT. PT. Fabioso (2005) adds PT. feed comprises 60-70% of the costs of layer egg production. 23%. a Korean company located in Indonesia. up by 61% on the same period in the previous year.] (ibid). Production exceeded the pre-crisis level only in 2002 (Fabiosa et al 2004). Aside from poultry farming and feed production and distribution. butcher shops and fast-food restaurants. has estimated its 2008 sales at Rp12 trillion ($1. which is owned by PT. Extrapolating from 1997 numbers (the last year for which aggregate figures are available). and PT. Jakarta Post 28/11/08 56 Interview. Galur Palasari Cobbindo are also significant players. Jakarta 27 November 2008 57 PT Sierad Produce produces on average 80 million Day Old Chicks per month.000 birds.html accessed 5 December 2008 PT. with Java having 60% of the national flock. a collaboration between Bogor Agricultural University (IPB) and SHIGETA Animal Pharmaceuticals Inc. Typically in Europe or the US.8% market share). In the same period. and roughly 80% of imported corn is used for the production of poultry feed (ibid:1). Multibreeder Adirama Indonesia Tbk. PT. Leong Hup [Leong Hup Holdings Bhd. Sumiarto and Arifin (2008:10) suggest the first three of these companies have shares of total production equivalent to 27%. and 19% respectively. Cibadak Indah Sari Farm as large producers. the company generated Rp9. Charoen Pokphand Indonesia. 7% layers. and much of the growth since then has occurred through vertically integrated production units controlled by a limited number of large-scale feed manufacturers.

supplying day-old chicks. Open trucks are commonly used for long distance trading. Integrated producers dispatch roughly 30% of their output through modern processing and slaughterhouses. Figure 1 presents a schematic. for example.000 birds daily. which many think have been injected with water. supermarkets and food processors. Eggs are collected daily and sold unwashed to local traders who distribute them. and you have the virus flowing everywhere”61. citing limited information and knowledge.45 kg per head. who usually provision the household. consider it safer to purchase a live bird and have it slaughtered than to buy a dressed bird (Padmawati and Nichter 2008). Chicken is the most popular meat in Indonesia. 60 Interview. feed. Further schemes extracted from two detailed studies are in Appendices C and D. In other areas small-scale entrepreneurs claim to be excluded. 59 KOMNAS Presentation. Most layer farms are privately owned and operated. who gain from the status quo (Kristiansen 2007). Supermarkets are not trusted. but more locally.6 kg.000 birds.40 days before returning them to the distributor or selling them to traders. most notably Newcastle disease. If birds become ill or stop producing eggs. and the traders will supply local and national markets. For many. A remarkable concentration of layer egg production exists around Blitar in East Java. the distributor will sell on to established clients such as restaurants and hotels. As one informant put it: “If you were going to design a system to spread an infectious poultry disease.000 to 400. and reduced consumption of rice and other starches. ranging in size from 500 to 15.2 billion chickens are consumed each year nationally59. Imports in 2005 were minute at 2 kt. with farms varying in size between 3. and exports were minimal even before the HPAI outbreak. Women. or is consumed at home. ‘halal’ slaughter is important. it would look something like this. especially as suppliers of frozen chickens. even buses. Usually. Bogor. Such birds are (or were) often eaten or sold to petty merchants who visit farms to buy such birds (Padmawati and Nichter 2008). Indonesia does not have the sanitary standards required for export to the European Union and Japan. 50% of the total broiler production was sold as live birds. 10 National Veterinary Conference of the Indonesian Medical Association.before the HPAI outbreak. live markets account for 80% of the chickens consumed each day. motorcycles.4 kg and pork at 2. transport is by whatever means is at hand: trucks. Farmers in the area complain that large cartels and their outreach of poultry shops and traders are strangling smaller producers. and 70% to traditional outlets (Fabiosa 2005:5). all independent production goes to an estimated 13. In Jakarta. Close ties are maintained between a number of large-scale feed producers and dominant groups of egg collectors and traders.000 and 100. Jakarta 27 November 2008 61 Interview. In addition to 70% of commercial production. Combine it with the number of backyard birds in Indonesia. on average 5-10% of birds were lost to illness. medicine and sometimes vaccines to contract farmers. Typically between 500 and 5. Normile and Enserink (2007:448) calculate this to be 300. 20 August 2008. and uncertainties due to the concentration and market dominance of powerful business groups. In 2005 national consumption was around 1000 kt or 4. and exports zero (Vanzetti 2007:4). The Indonesian experience fits the common pattern of rising incomes and urbanization leading to increased consumption of animal protein.000 birds. Jakarta 26 August 2008 24 th . The integrated broiler production system is a complex web of activity centred around poultry distributors who usually act as agents for large poultry companies. In 1999.000 live poultry markets. Manure is harvested and dried for sale to farmers who use it as fertiliser. KOMNAS figures suggest that around 1. but interviewees suggested that the figure is probably closer to one million60.200 farmers who then raise the chicks for 33 .000 chicks are supplied to a set of 20 . which generally sell to restaurants. compared with beef at 2. they are usually eaten by the farmer or sent to market.

rivalry and no understanding that there is a shared interest”62. and are actively trying to find and deal with the virus. Government and industry need to form a partnership with the same objective64. There is no tradition of co-operation for the common good. attitudes have changed a bit. The only way you know that there is a die off is when you see the smoke from the fires. Pointing fingers don’t work63. They know which side their bread is buttered on. There’s commercial competition. Market chain for layer birds on Bali (Thornton 2007:5) The lack of regulation and the self-imposed self-sufficiency of the industrial sector have not helped the situation. but if they are going to be brought in to the dialogue. there’s nothing to say that you have to report. Involving industry meaningfully is one of the most important practical things that can be done. but they are used to looking after themselves. They are isolated. Jakarta 28 August 2008 64 Interview. One interviewee explained: “It’s murky and secretive. They don’t trust the government’s intentions or competence. Another said: The big integrators are willing. The biggest companies are completely integrated from feedstuff to fried chicken shops and have influence at the highest levels. We know what we are doing. ‘leave us alone. That’s the problem’. through vaccination mainly. they have to be spoken to in their own language. or trucks of disinfectant going in through the gates. Jakarta 15 August 2008 25 . Some companies are talking more. in many cases quite happily. There is no tradition of dealing with animal diseases. Jakarta 15 August 2008 Interview. but they say. They know what bio-security is. Please go and sort out the backyard farms. Even if there was a law that was enforced. But there has not been as much focus as there should have been on industry and building relations with them. They know they have a problem but they don’t expect any solutions to come from the government. Another respondent offered a slightly brighter analysis: In the last year and a half. 62 63 Interview. Some of them practically dip their workers in disinfectant at every step.Figure 1.

of a conception of public goods. The Javanese language has very formal forms associated with speaking to someone of a higher. The government network. In Indonesia. They range from the desperately poor to comfortably-off hobbyists. and the government. and The World Bank. This concept is not familiar. Backyard farmers too generally have no common voice. the maintenance of individuals’ houses and communal irrigation ditches and terraced rice-paddies. even the large and mid-sized producers consider themselves as having little in common. whilst medium-sized producers are more likely to acknowledge outbreaks in order to seek assistance and compensation from the government (Simmons 2006).org/docs/9464/OWOH_14Oct08. But the different strata of society do not see themselves as having anything in common – of being in the same boat – in any way.There are therefore a remarkable number of actors involved in the Indonesian HPAI epidemic. an urban development observer suggests: 65 Contributing to One World. and the millions who consider backyard birds an important part of everyday life. processors. and it is still common to see. in the international community (and not mentioned in the international consultation document quoted). according to geography largely. beyond their immediate geographical locations. susceptible to media excitement. nor supplied efficiently’. consumers have few rights in Indonesia. available at http://www. meaning ‘mutual help’. domestic public goods and national public goods. WHO.undg. The context of the consultation is international public goods. the lower ranked physically stooping in the presence of the higher ranked. and the government tends to interact with them ad hoc. One Health .pdf accessed 29 November 2008 26 . retailers. This doesn’t mean that the well-todo don’t care for the less-well-off. Short of not purchasing items and staging protests. over a million people are closely involved in industrial production: farmers. Quite the opposite: there are well-defined protocols of responsibility associated with higher rank. The highly stratified nature of Indonesian society is probably the most significant factor in this weak understanding of public goods. produced by FAO. only the concept of local public goods has much traction.A Strategic Framework for Reducing Risk of Infectious Diseases at the Animal-Human-Ecosystems Interface. Whilst this extends (in some parts of the country) to the manning of local security/emergency posts. Large producers are more concerned about a consumer backlash and are keen to deny the existence of disease outbreaks publicly. The government is also involved. and are still a very long way from seeing that they have any interests in common with the backyard sector. Aside from chicken meat and egg consumers. and the challenges of avian influenza in Indonesia become clear when the associated networks. Similarly. regional public goods. UNSIC. It certainly does not extend to the extermination. which are consequently neither priced. for example. October 2008. Underlying these disconnects is a lack. UNICEF. feed suppliers. but distinctions are also made. still finds itself fundamentally torn between industrial and small-scale agriculture (as well as other imperatives) and very largely lacks any means of interacting with industrial producers except for the relatively opaque informal communications that are a legacy of Suharto’s corporatist era. A recent international consultation document65 defines public goods as ‘non-rival in consumption and having non-excludable benefits. Commenting on Jakarta’s neglected public parks. between local public goods. even though it would prefer not to be. of an invisible virus. OIE. or popular. industrial producers. for example. a lower. and form only fragmented networks. backyard farmers. are considered. or an equal rank. and notions of centrally managed facilities for refuse disposal are very recent. These actors can be resolved into four main groups: consumers. it does not extend to the provision of safe pedestrian sidewalks. or management. or networks. and response. and inconsistently. following specific protests for example. despite significant attempts to co-ordinate a coherent position. or the lack of them. for example. or an undeveloped sense. expressed by the phrase gotong-royong. the industrial producers are only just coming to the realisation that they have shared interests amongst themselves. even in the most enlightened sectors of Jakarta society. Add decentralization and the picture becomes even more complex. transport personnel and shareholders. wholesalers. As yet.

property and telecommunications. Consequently. The following section will explore this issue in the context of the response.html accessed 28 October 2008 27 . The national co-ordinating body is the Komiti Nasional Pengendalian Flu Burung dan Kesiapsiagaan Menghadapi Pendemi Influenza (KOMNAS FBPI). the needs of the poor were primarily addressed through mechanisms of paternalistic charity. In the bad old days. The executive team includes six task forces that provide direction on research and development. Anderson 2006). and a net worth of $5. Keeley and Scoones (2003) 68 Forbes listed Bakrie as Indonesia’s richest individual in 2007. and there are further concerns about the livelihoods of the poor. as is still the case often today. The Departemen Pertanian (Deptan). No one would argue that even the local eradication of virus associated with a deadly animal disease is not worth attempting. or the National Committee for Avian Influenza Control and Pandemic Influenza Preparedness. proclaiming global public good objectives. there is a dawning realisation that sustaining such fractures.4 billion http://www. and where an international public good appears very distant? THE RESPONSE: NATIONAL AND INTERNATIONAL NETWORKS AND NARRATIVES67 Actors associated with the HPAI response include national. Also relevant in this numinous culture is that such a universalistic concept as a public good is most often seen as a matter best left to one or more deities. headed by the Coordinating Minister for People’s Welfare Aburizal Bakrie68. and more. In nearly all matters of state there are conflicting narratives.forbes. and no question of legitimacy was associated with the accumulation of either (cf. smoking in public places. and the government is uncertain as to its role and responsibility in negotiating and forming them into a broadly utilitarian response that might be called a public good. the army commander. and traditional concepts such as gotong-royong were promoted to encourage the poor to look after themselves. mining. The committee has 14 members. The international response to HPAI is largely driven by a sophisticated concept of a global public the police chief. or Ministry of Agriculture (MoA). and economic growth and prosperity. contested and highly contingent. and food security. a host of questions are arising associated with taxation. National Planning (Bappenas) and Industry ministers. supported by the United Nations World Health Organization (WHO). This sets a conceptual challenge for the government of Indonesia’s young democracy in formation. Health. including the Agriculture. but also dangerous for political stability. or Ministry of Health (MoH). as illustrated by slogans such as ‘One World One Health’. where notions of public goods are fragmented.We (Indonesians) are averse to mixing with all layers of society… This socio-cultural problem is one of the reasons why parks in Jakarta are yet to become melting pots. the provision of public services. created by presidential decree on 7 March 2006. What happens when the international community. but the funds and the attention that have followed the spread of avian influenza have largely been generated by the possibility of H5N1 evolving into a form that causes a human pandemic that kills millions. and the chairman of the Indonesian Red Cross. Forestry. 24/11/08 cf. where people from all social layers gather together66. Then. supported by the United Nations Food and Agriculture Organization (FAO). money simply followed power. arrives in a place like Indonesia. animal health. is in the front line. and shakes stock markets and societies worldwide. with interests in infrastructure. representation for minorities. is also involved. This is a ministerial-level committee. Now. human 66 67 Jakarta Post. and structures. The Departemen Kesehatan. international and regional organizations. in society is not just morally ambiguous. the Economics co-ordinating minister. objectives and interests at play.

Jakarta 25 August 2008 74 Interview. with communications supported by the United Nations Children’s Fund (UNICEF). with $117. Another interviewee suggested: “The Ministry of Agriculture doesn’t talk to the Ministry of Action research 10.15 million in grants (including $25.3 million for control.9 million. Another plan was 69 70 See Kalianda (2008) for details of the instruments involved. of which $89. This stipulated that they should prepare plans. and report every three months. the third. with the chief executive of KOMNAS seeking $300 million annually71. and both organizations are required to coordinate with KOMNAS.18 million from the US. information and public awareness 7.39 million disbursed.6 million committed and $56. Management of human cases 3. KOMNAS and the related agencies are guided by the January 2006 National Strategic Plan for Avian Influenza Control and Pandemic Preparedness70. the situation could look very different today. Strengthening relevant laws 8. Jakarta 15 August 2008 28 . This outlines ten strategies based on principles advocated by the FAO. Further to the presidential decree of 7 March 2006. the government allocated $57. Available at http://www. They see AI as their problem and ask why another organization should be involved.45 million from the US) and in kind (including $39. In comparison. Risk communication. Capacity building 9. Monitoring and evaluation In 2006.16 million from Japan and $8. The most important point however was the last: the costs were to be borne by the regional local governments69.97 million from Australia. $16. This is the most committed to any country72.94 million had been disbursed (UNSIC & World Bank 2008:87). and in 2007. take the required operational steps. At the national level the response requires co-ordination between the MoA and MoH. Vietnam. funding at this stage. At the Bali simulation in April 2008. Control in animals 2.go. And another said: Agriculture and Health hate the KOMNAS role. This adds up to a complex set of relatively well-funded networks. the MoH would not let their people wear the official jackets as they had KOMNAS on them. vaccine and anti-viral medicines. the WHO and the World Organization for Animal Health (OIE): 1. and $12 million from the Netherlands). At 30 April 2007. and in September 2008 USAID obligated an additional $20 is the second largest beneficiary. and vice versa. on 9 May 2006 the Ministry of Internal Affairs issued a letter asking the regions to work with KOMNAS. This creates difficulties familiar to anyone who has worked in any civil service. and provide. and a similar structure has been established in a number of provinces.komnasfbpi. and Nigeria with $58. Protection of high-risk groups 4. Had central government been in a position to assure. Politics and personalities get in the way”74. 73 Interview.85 million. Epidemiological surveillance for animals and humans 5. and mass communications and public information. the USAID contribution alone to Indonesia was $42. monitor. “We have two plans in one binder and call it ‘integrated’”. the international community had committed $128.pdf accessed 1 November 2008 71 Jakarta Post 12/09/2007 72 At April 2008. Restructuring the poultry industry 6. $52. says one closely involved respondent73. evaluate.33 million committed and $38.14 million disbursed. A secretariat and a media centre aid coordination between the ministries.

between the national and international agencies. but that’s not helping. Jakarta 28 August 2008 79 Interview. which they don’t like one bit. A significantly smaller WHO team works out of more central MoH premises. The international agencies. We just use ‘pandemi’. especially when combined with that of donor organizations like the EC. and other international agencies. Yet another informant explained: KOMNAS has the expert panels. or goes to the same parties) also clearly pertains to the relationships. less so. Jakarta 15 August 2008 78 embed KOMNAS in the MoA. KOMNAS then makes recommendations to MoH or MoA. Jakarta 28 August 2008 80 Interview. We have no picture of pandemic. and are challenged in their own ways by organizational. Another interviewee. The same issue of personality (or who has whose hand-phone number. Jakarta 12 August 2008 Interview. this is our business’. very scientific and this does not fit the local context well. is that: “The UN is not ultimately solution-driven. Perhaps the greatest fracture between the national and the international is in the conception of a human pandemic. of course. have their own cultures. just saying ‘yes’ to the boss. every Indonesian interviewed admitted that they did not believe a pandemic would occur. a large FAO team is firmly embedded in the MoA. In some cases it is obviously very good. facilitating. It is even worse in the regions76. in others. where and magnitude. The science is important but it is not a solution on its own”80. Jakarta 15 August 2008 29 . There is a culture of playing safe. You would not believe the level of dysfunction that exists. Everybody is very busy. One explained: We have no word for pandemic. which are fine as far they go. ‘no way. very focused on their jobs. described by an interviewee. but this is not pandemic. We have ‘wabah’ for outbreak. disciplinary and professional divides. And implementation depends on the ministries. This is a very deep tradition. There’s now talk of disbanding KOMNAS in 2010. and UNICEF and UNOCHA (Office for the Coordination of Humanitarian Affairs) both have independent offices. In Jakarta. But candidly. but MoA said. There you find a traditional culture. and it’s easier to find space for someone else’s problem if you get on with them78. and it’s hard work making them fit”77. One respondent suggested: “The internal [UN] bureaucracy is not helpful. Accepting the uncertainty of when. and almost without exception. just adding to the air of uncertainty75. That is clearly not happening here”79. All of the scientific findings go to it. bemoaning the “deluge” of staff coming and going on short-term contracts. Another explained: “The focus of the response is very. to the south of the city. Initiative is not applauded. sees personality as key to co-ordination: There are monthly meetings between the agencies. The government has to drive the solution. We have no history of events like the Black 75 76 Interview. meetings at social events – but these depend more on whether people get on. but deeper issues are involved in the mix. the international agencies and the individuals involved with them appreciate the science of viral evolution and the associated inevitability of a human influenza pandemic. It needs a revolution to make any changes. One of the biggest challenges. and co-ordination. with UN. The priorities of the donors are not necessarily the same as those of the country. which are not exactly nimble. There is also informal contact – phone calls. Bogor 21 August 2008 77 Interview.

doctors and communications specialists creating and driving modernist sub-narratives of surveillance. Jakarta 28 August 2008 83 Interview. arrives in the vague and relatively unruly world of the Indonesian countryside? CHASING THE CHICKENS “The plan was put together in a hurry in order to have something for the Beijing meeting85. but it was a good plan. increasing complexity. and industry restructuring. It’s like talking to people who don’t drive cars about the importance of wearing seat-belts”83. including food security. control.18 January 2006 86 Interview. developed a National Strategic Work Plan for the Progressive Control of HPAI in Animals for 2006 – 2008 (Ministry of Agriculture 2005). animal quarantine. and the emergency nature of the response.Death. and the competencies and responsibilities of the international agencies involved. Healthcare workers need to buy in to it. and poverty? Only now are alternative narratives. The scale of the problem. In mid-2005. 5% sick and 5% injured. 17 . the here and now”82. But the average citizen does not care. the fourth most populous country in the world. research and development. divided into sections covering agriculture. Beijing. Further details of the response are offered below. and another paper pointed to the unacceptability of a transport system that results in up to 5% of animals arriving at market dead. legislation and enforcement. As the quote above 81 82 Interview. budget of $322. or vice versa. and proclaiming public good objectives. It had an indicative. In Indonesia.000 over three years and consisted of nine elements: campaign management. (Mudiarta et al 2008). startling evidence was presented of the detection of the H5N1 virus in nearly half of 83 poultry markets surveyed in Java (Indriani et al 2008).146. has precluded much in the way of reflection. It is not part even of our imaginary world. 85 International Pledging Conference on Avian and Human Influenza. they have set themselves the task of implementing a rigorous and consistent set of programmes in a highly decentralised and politically dynamic environment which has not. Most people have more urgent and important things to deal with81. But what constitutes an ‘effective’ response in the views of these different players? Is a science led. enhancement of HPAI control in animals. or helpful? A bigger one is what happens when the international community. the MoA in collaboration with FAO. driven and justified by science. WHO. An (international) interviewee said: “There is no conception of the pandemic threat. Wald 2008). and other international partners. demographic change. Everything is driven by the short term. ecologically and culturally most complex. At the same conference. change in human behaviour. Another suggested: “There are people working on the problem who care. These distinctions reflect both the national administrative structures. communications. food safety and animal welfare84 being proposed as relevant to HPAI in Indonesia. risk mitigation framing obscuring the sorts of disease drivers and related factors Farmer (1996) identified: ecological change. Politicians need to buy in to this. Jakarta 13 August 2008 30 . surveillance and epidemiology. Jakarta 14 August 2008 Interview. and ambitious. laboratory services. The challenge is to make it work”86. with veterinarians. and one of the geographically. provided the opportunity for significant trust to develop between civil society and authority. Thus the scale of the challenge for the international organizations leading the response to HPAI becomes clear. as yet.2 billion chickens consumed annually. and behaviour change. and the response to date has been driven by an overarching ‘outbreak’ narrative (cf. human health and communications. Jakarta 11 August 2008 84 The chief executive of KOMNAS began his key-note address to a national veterinary conference on 19 August 2008 by suggesting that AI threatened the supply of the 1. One question is whether such divides are appropriate.

000. and if positive implement a cull in the immediate area. Early in the outbreak. its production was driven more by an international timetable than a national one. close to where the first fatal human case had occurred. had had 2. especially if no family members appear to be sick. humans living nearby are sometimes tested too.000 birds destroyed and was paid Rp2. Only three days later however. vaccination. surveillance and community awareness. In endemic areas MoA staff will then collect samples from sick or recently deceased birds. and there are practical difficulties in distributing any funds that might be available. perform a rapid test for Influenza A. Until late 2007.000 per bird. The focus then turned. In some areas HPAI is referred to as ‘new’ or ‘strong’ Newcastle disease (tetelo) or just ‘plok’. stigma associated with having an outbreak (Padmawati and Nichter 2008). But poultry market prices differ from one region to another. Most surveillance is now active – MoA teams are actively searching for cases in the field – but faced with poultry deaths showing clinical signs of HPAI.000 ($1 approximately). the policy was extended to include mass culling within a radius of three km of infected sites and testing within 20 km. A Campaign Management Unit (CMU) within the Directorate General of Livestock Services (DGLS) was charged with implementation through nine Regional Management Units (RMUs). Jakarta 13 August 2008 31 . To date. which he claimed had been negotiated down by government officials from the official Rp10. and compensate small farmers87.42 million) was set aside to finance the measures and compensate farmers88. Anton Apriyantono. and by mid-2008. saying that the government lacked the money to live up to its promise89. and movement controls. only 31 pigs and 40 ducks were slaughtered. with only farmers having flocks up to 5. There is often suspicion of government officials. “very restricted voluntary culling” had become the norm91. in January 2004. many backyard farmers are reluctant to report die-offs. An informant explained: 87 88 Jakarta Post 30/1/04 Jakarta Post 22/7/04 89 Jakarta Post 25/7/04 90 Jakarta Post 12/11/05 91 Interview. As part of the integrated plan. and uncertainty about how to identify HPAI (particularly how to distinguish it from Newcastle disease) and to whom outbreaks should be reported. an egg producer. to focal culling and ring vaccination. Despite a significant decrease in the number of scavenging chickens in some urban areas. which were based around nine Disease Investigation Centres (DICs) and 35 Local Disease Control Centres (LDCCs). in line with international advice. Commercial farmers are supposed to report the event to their distributors who inform the local livestock services office. backyard farmers are supposed to contact their village head who informs the local livestock services office.5 billion ($8. in Tangerang.indicates. with the Minister of Agriculture. disease control has focused on culling with compensation recommended.000 eligible. and Rp82. One interviewee. not every die-off is a result of HPAI. which sends a veterinarian to do a rapid test and/or take samples to a laboratory for PCR and virus isolation tests. improved biosecurity. Later that year. the government responded to international pressure by announcing that it would cull infected birds. strategically at least. the value of each culled chicken is set at Rp10. this activity was almost exclusively focused on the ‘backyard’ sector. the sound of a dead chicken falling from a perch (Normile 2007). with Apriyantono explaining that mass culls would cause serious social unrest90. Simmons (2006:442-3) found only one of five producers interviewed on Bali and Lombok had been compensated. According to government decree. In practice. Compensation has arguably raised more problems than produced solutions. this pattern of unfulfilled intention has very largely been repeated across the country. in July.

and then a booster every quarter. Confusion has also arisen regarding the legality of importing vaccines. Jakarta 13 August 2008 32 . Imagine… you arrive in a village with 500 chickens wandering about the place. 92 93 Interview. equity are all alien concepts92. Mass vaccination is doubtlessly hard to accomplish in a backyard setting. and a scandal erupted in October 2005 in which officials were allegedly complicit with vaccine producers in lowering vaccine quality in order to boost profits95. particularly China. The compensation itself becomes a matter of individual negotiation. In all each bird will need five or six injections over a year – an initial dose. The eye of the needle Vaccination. and deliver it correctly to the relevant animal. it’s hard to make a system work where you have to deliver small amounts of cash to large numbers of people. In the long term it is just not sustainable96. and the right equipment. which decreases susceptibility and virus excretion. The provinces are supposed to make an estimate and send a request to central government. Jakarta 11 August 2008 Interview. a decision was also made to prioritize control in animals. as these were determined to be most likely to impact on the spread of the virus (Samaan 2007). and information and public awareness. with eleven of the most affected provinces targeted94. is a familiar procedure in the industrial sector and widely used for a variety of poultry diseases. One respondent explained: In theory vaccination solves the problem. and there are many cases where a farmer has applied for compensation even though he knows that they have not died of AI”93. This means that the catchers and the vaccinators will need to visit five times with the right vaccine which has been sourced and stored properly. but is unusual amongst backyard and mid-sized operations. mid-2006 saw a change of strategy to targeted vaccination using an inactivated LPAI vaccine. epidemiological surveillance. but there is not enough and the mechanism is unclear. Jakarta 13 August 2008 94 ‘Vaccine shortage hampers government's bird flu fight’ Jakarta Post 11/04/06 95 Jakarta Post 8/10/05 96 Interview. Mass vaccination was first proposed in March 2004 with plans to provide 300 million doses of a locally produced vaccine – an inactivated H5N1 isolate from the Legok strain – free of charge to backyard and small farmers. Thornton 2007). a booster after three weeks. Implementing and managing mass vaccination campaigns in backyards and villages is a different order of activity from vaccinating in relatively ordered industrial settings. Infrastructure. There are no fences and no coops. They belong to everybody and nobody. including Newcastle disease. Another respondent described the other side of the coin: “Chickens die for all sorts of reasons. which will then disburse funds. but implementing it on the scale required here is impossible. At that time. and owners are suspicious as birds sometimes die after vaccination (Padmawati and Nichter 2008). efficiency. but a/ how do you make an estimate in these circumstances. and is unpopular with veterinarians. It requires repeated administration. and Indonesia has achieved only partial success (cf. A cold chain is required and Indonesia has seen recurring controversies over vaccine quality from both domestic and foreign suppliers.There is money available. b/ any estimate then becomes a subject for drawn-out negotiation and c/ in a low-wage environment where it is culturally acceptable for everyone to shave a slice for themselves or their organization. Due largely to limited vaccine supply and a realisation of the costs of such large scale provision. probity.

In Bali. the price is only Rp30. technocratic. 20 . and is responsible for protecting each island from contamination by foreign and domestic animal diseases. While in East Java. Italy. but in theory at least. The director of one of the leading avian influenza designated hospitals has suggested that improper vaccination may be helping to spread the virus100. 97 98 Jakarta Post 8/08/07 KOMNAS presentation at the 10th National Veterinary Conference of the Indonesian Medical Association. high variegated. Commonly quoted statistics suggest that there is one vet active for 20. smuggling ducks from East Java province to Bali province. 99 Ministry of Agriculture presentation ‘HPAI Vaccination Program in Indonesia’ at Scientific Conference on Vaccination. In March 2007. Jakarta 28 August 2008 102 Interview.This situation is exacerbated by a lack of veterinarians and appropriately skilled people.000 each. Another smuggling area is Lampung to Java. duck price can up to Rp35. Poultry also continued to be smuggled.000 people or 4. It is however not under the control of the Directorate of Animal Health and suffers even more severe challenges of competence and resources than other parts of the national civil service. or moved by small traders who were unaware of the ban. transport of live birds (including fighting cocks) was banned between Java and the eastern islands.500 sq km. Example. Ketutsutawijaya103 suggests: Poultry smuggling in Indonesia can happen from island to island. particularly in provincial and district government service. Five veterinary faculties ( accessed 3 November 2008 33 .wordpress. and that costs per year would total $166.000 each (kampong chicken). It should be noted that the complex geography makes comprehensive control virtually impossible. international-led solution running into the finely grained sand of Indonesia’s numinous. However DGLS certified day-old chicks and chilled and frozen poultry meat were still traded (Simmons 2006:442). Another said: “We have some answers and one of them is that mass vaccination is NOT a strategy in Indonesia”102.000 each [sic]. there is a chance that HPAI could have been contained on Java. The Quarantine Service operates under Regulation 82 of 2000 on Animal Quarantine. Vaccination seems to have repressed the virus to a degree. In 2004. Smuggling is common due to the price differentiation is so big between each areas [sic]. Bogor. The medical community too has reservations about the vaccination programme. East Nusatenggara are considered the worst provided for) having only one or two vets98. There are also questions about the virus strains being used. including Bali and Lombok. Chicken smuggling from Sulawesi and Surabaya heads to Papua. and industry provides better wages than government employment.000 vaccinators were needed for the country. and that “half of the posts are not functioning”97. here-and-now culture. While in their origin place (Sulawesi and Surabaya). duck price only Rp15. chicken price is up to Rp150. A senior veterinarian with the Bogor Institute of Agriculture. Bogor. 19 August 2008. and with some outer provinces (Papua. the MoA estimated that 154. Vaccination is a clear example of a rational. Yogyakarta. since many people demand ducks as one of the main component in their religious ceremony. Verona. with less than 20 working on average per district.00099. is quoted as saying that there are only 200 animal health posts nationwide.22 March 2007 100 Jakarta Post 14/09/06 101 Interview. Jakarta 12 August 2008 103 Available at http://ketutsutawijaya.593. Maluku. Another is the notion of clear and comprehensive movement controls. and smuggling city to city within the same village [sic]. The vaccine is too widely dispersed and there is no monitoring of drift. but it may well just be concealing the virus and complicating surveillance101.000 each. In Papua. had this agency been aware and active in the early days of the outbreak. Surabaya and Bali) produce only 70 to 120 graduates a year each. An interviewee was more explicit: Half-baked vaccination programmes do nothing to help.

According to Padmawati and Nichter (2008:40) testing delays are often used to ‘harvest’ healthy chickens. including 353 qualified veterinarians and 945 people with no official animal health qualifications. Jakarta 14 August 2008 Interview. a broader village-level approach encompasses all poultry farmers. a collaboration between the Ministry of Agriculture. movement controls implemented. Jakarta 13 August 2008 106 The influenza type A rapid test (Anigen©) only distinguishes between HA or HI virus/titers. Science meets society Since January 2006 the core of avian influenza control in Indonesia has been the Participatory Disease Surveillance and Response (PDSR) project. Now. you simply pay a tax and go on”104. supported primarily by USAID. and enlisting the local population in control efforts. responded to 6. prevention and control of all poultry diseases. training and managing a large number of staff spread over a wide geographical area. and the government of Japan. 2. From January 2006 to September 2008. Four pilot studies were initially run in four LDCC (Local Disease Control Centre) locations across three provinces in Java. which is then sent to the MoA. infected properties disinfected. and results may not be available for a week. a greater stress is put on empowering communities to understand the origin.112 officers. The first phase of the PDSR project emphasized the detection and control of HPAI by separate surveillance and response teams primarily in ‘backyard’ settings at the household level. involving 52 local government livestock services officers. negatives need to be confirmed. By mid-2008. with the objectives of gaining trust from the community and understanding historical and active poultry disease better. One respondent explained: “In the poorer parts of the eastern islands. for example.1 million community members107. where capacity is being developed through PDSR. the teams have rapid tests106 available to confirm HPAI. Supported by large-scale awareness campaigns in the national and local media. traders and community leaders. since 1 April 2008 the database has been based on the village as the epidemiological 104 105 Interview. PDSR teams made 177. many houses are not much better than what would be called chicken coops in the West”105. After an initial focus on households. and can take only two hours. bio-security and the disposal of infected carcasses. but a laboratory is required. PCR (Polymerase Chain Reaction) tests are more specific. A definitive isolation test – culturing the sample in a medium – usually takes seven to ten days. and the local medical authorities or District Surveillance Officers contacted. When active outbreaks are encountered. infected birds are subsequently culled and disposed of. the FAO-supported project has grown into a remarkably large enterprise involving recruiting. 107 FAO unpublished 34 . In its totality.As an interviewee put it: “Anybody can move anything around. It has much in common with established techniques of participatory rural appraisal (PRA) but has evolved significantly in Indonesia. local government livestock services and the FAO. The project is based on a qualitative approach to epidemiology known as participatory epidemiology. the PDSR teams visit villages.011 cases of HPAI and worked with over 2. which has the objective of developing and supporting a communitybased response to detecting and preventing the disease by using local knowledge of where and when outbreaks are occurring. If you are stopped. Each team reports their activities to a LDCC. which enters reports into a LDCC database. meet with community leaders. key informants and poultry farmers. AusAID. and with support from the affected community. where all LDCC databases are compiled into a central database.306 surveillance visits. There is legal and illegal trading over a vast area. and better links are sought with veterinary services. Similar practical issues often pertain to matters such as caging. were operating in 27 of 33 provinces across 331 of Indonesia’s 448 districts. Much work has also gone into database development and management.

This sometimes has the required outcomes. and incorporates conventional. Another suggested: “The expansion has been too fast. especially in its second-generation form. Jakarta 26 August 2008 115 Two remarkably detailed and relevant studies completed in association with the FAO in 2008 are: ‘Poultry Market Chain Study in Bali’ by Made Mastika (OSRO/RAS/602/JPN) and ‘Poultry Market Chain Study in North 35 . The second phase of the project has also broadened the range of stakeholders involved to include district. Looking to the future. Non-veterinarians associated with the broader response comment admiringly on the scale of the operation. and the data-collection. is providing an understanding of the dynamics of disease spread and control that just did not exist before. has been struggling to obtain the appropriate tax-exempt status for 480 motorcycles before deploying them to the field112. approach represents a significant attempt to meet the requirements of Indonesia’s diverse complexity on its own terms. One interviewee suggested: 108 109 FAO AIDE News July 2008 Interview. prevention and control programme that addresses other animal and zoonotic diseases in the way that the One World One Health initiative is calling for110. Other FAO-supported activities include running workshops designed to inform and enlist local government officials and decision makers. As one respondent put it: “FAO is tasked with making this happen in the field but FAO is not traditionally an implementer on such a scale. and studying poultry movements. Jakata 27 November 2008 111 Interview. Jakarta 12 August 2008 112 FAO Eleventh PDSR Quarterly Report. its organization and sense of purpose109. April-June 2008 113 Interview. is that communication with industry is better given hard facts about what is going on in the environment surrounding their facilities115. processing and analysis system. but what is required is an assured. I’d say that it is projects like this that stand the best chance of helping to rebuild veterinary services post decentralization and the financial crisis. newsletter and communications production. the PDSR project is doubtlessly a success. Other respondents.unit108. the programme has had significant success in disease control. some very prosaic and frustrating. They don’t have the authority to cull. They can’t vaccinate. This is one problem of being driven by donors. It is working remarkably well with MoA. how fast can you go? Here we train people for two weeks and push them out of the door. One suggests: The problem is with the R in PDSR. There are other challenges. and to evolve into a surveillance. provincial and central governments as well as local communities. and the human face it puts on a necessarily massive enterprise is valuable. At a number of levels. All they can do is talk. One less obvious good. the high number of reported cases for Indonesia in 2007-8 is due entirely to PDSR. boots-on-the ground. We’ve created a response platform. The FAO. commercial industry profiling. which is seen as tangible by some. The locally orientated. quantitative epidemiological techniques. but the strategy is questionable”114. The teams can measure but they can’t respond effectively. An interviewee associated with the project said: In some areas. but I do wonder whether the role of the organization is to run a branch of the national civil service” 113. marketing and socio-economics. Jakarta 13 August 2008 114 Interview. some close to the project. such as Lampung province in Sumatra for example. developing procedures for collecting and transporting virus samples for laboratory testing. testing vaccination protocols. are more critical. Jakarta 12 August 2008 110 Interview. standard cull and compensate response to isolated outbreaks111. for example. who are always asking how big can you make it. More widely. local-level focus group discussions.

Central Java and Yogyakarta).088 vaccinators. OR examines the feasibility and impact of alternative controls through a longitudinal study to measure the effectiveness and feasibility of four measures: a) a PDSR control group. Rasmaliah. even if this is now appreciated in the control room of the MoA. political complications exist further up the ladder. Led by the MoA. We know that small farms are awash with the disease. In these circumstances it’s difficult to put together a coherent programme”119. Another suggested: I don’t believe agriculture has a high enough priority on the national agenda – the future is seen as development through industry and services – and I don’t believe avian influenza is a high enough priority within the MoA. We are dealing with a number of donors too. and the time and effort that is going to be required to bring the disease under control. and it’s not supported internally. Alongside procuring and delivering vaccines and testing kits. One informant said: “There needs to be priority and focus. Even in this less than ideal political and operational environment. Even with all the work done to date. it is clear that the response is still in its relatively formative early days. The Operational Research (OR) project is one of the most ambitious and recent initiatives. there have been successes in controlling the disease in some regions. The problem is probably linked and self-perpetuating. c) PDSR plus HPAI and Newcastle Disease vaccination and d) PDSR with immediate compensation for culled birds. Funding is going down right now. Only now is that work starting to be done116. and monitoring. it’s ad hoc. working in collaboration with FAO and the International Livestock Research Institute (ILRI). but not much more. Jakarta 15 August 2008 117 Interview. Jakarta 15 August 2008 118 Interview. let alone doing anything about it” 117. Zulfikar Siregar. We are at the stage where we are snowed under just working out what is going on. and Rosdanelli Hasibuan (OSRO/INT/501/NET). There are people struggling to do good work. Nevy Diana Hanafi. Philipus Sembiring. will be required for years into the future. but it’s not resourced well enough. “At the moment it is simply a huge vortex that is sucking everything in. We know that industry has problems. A standard cull and compensate approach (‘stamping out’) is inevitably challenged and unpopular Sumatra’ by Albiner Siagian. We need to know more about the market chains. Jakarta 13 August 2008 36 . “We have to find them. You can’t successfully address a protracted problem like this on a year-by-year basis. However. But agriculture people don’t have the influence”118. 116 Interview. the project involves 1.” said one interviewee. b) PDSR plus HPAI vaccination. there are still significant uncertainties as to which aspects of the activities have been responsible. We need to know more about feed. and supervise them. This is basically an agricultural problem and agriculture should be leading. and that effort. and only the most long-sighted of the donors are prepared to commit to more than a year. together with the scale of problem. train them. the veterinary and agricultural responses to HPAI have been determined and well co-ordinated across a remarkably large geographical area and range of activities. and moving samples to laboratories. expertise and funding. and they have subtly different objectives. The CMU [HPAI Central Management Unit] sits too low in the hierarchy. Those close to the programmes are at pains to stress that despite the challenges. launched in June 2008 in 16 districts of three provinces (West Java.Industry is now more willing to talk about zoning and compartmentalization. employ them. By a lucky fluke the country is self-sufficient in rice this year and the minister thinks that’s enough. Ma'ruf Tafsin. Although relations between the international agencies and the government are significantly better in agriculture than in health (see Viruses and sovereignty below). it lacks influence. Dwi Suryanto. and by all accounts the FAO in particular has a good working relationship with the MoA. Jakarta 11 August 2008 119 Interview.

malnutrition and aging – avian influenza cannot even be described as a blip on the chart. It’s very difficult to make them understand as they have been farming like this for centuries. Of the 139 laboratory confirmed cases. also died123. Even though we were officials trying to help they were rude to us and didn’t welcome us. Compared with other causes of death in Indonesia – infectious and chronic diseases. such conceptions are not widespread amongst the population. and more deaths. Bali two cases and two deaths. In comparison. We have chickens but we are not sick’. A respondent involved in a socio-economic study in Jakarta explained: The people did not want to tell us they had poultry. feet. was reported in July 2005.”120 was how one interviewee put it. have a clear understanding of the necessity of a robust response. The first WHO lab-confirmed Avian Influenza A/H5N1 human case. which they are not. Jakarta 12 August 2008 123 One explanation for the time-gap between outbreaks in animals and human cases is that the animal outbreaks initially occurred in the industrial sector where there was limited human contact with diseased birds (Samaan 2007:18). as discussed previously. 113 have been fatal. than any country in the world. and death. This. manure and more. at least undervalued. “It only takes one chicken. They hid from us and they hid their poultry from us. people do sometimes get sick. text-book style. whose two daughters. lax regulatory regimes and under resourced and inefficient enforcement processes. feathers. and Sumatra 23 cases and 14 deaths. placed there most clearly by those who have been in the field trying to do it. and the (global) public good attached to it. They say: ‘Look at us. the ultimate technological fix. Indonesia had more human cases.121 As ‘enhanced bio-security’ emerges as a further component of the veterinary and agricultural response. HUMANS AT RISK? “The biggest issue is that there is practically no understanding of germ theory in the population. the educative potential of trained people on the ground is going to become even more important. along with trust in them and what they say. as illustrated by the final comment in the previous section. and Banten (on Java’s most western tip) have seen the majority of events with 95 cases and 81 deaths. if not ignored. accidents. As will be discussed in the following section. By 12 December 2008. meat. however. What is more difficult to measure. East Java seven cases and five deaths. transparent and timely. is the human face presented by thousands of people on the ground concerned primarily with the welfare of poultry. West Java. and die. and that ignores feed. South Sulawesi one case and one death. but a question mark hangs over the practicalities of implementing it across every village and backyard in the country. and what therefore is in danger of being.unless the mechanisms and delivery of compensation are consistent. We were blamed. causes a huge disconnect between the (global) public good construction driving the eradication of HPAI. 37 . They said we were stupid. Whilst those involved in managing the response. a 38 year old man from Tangerang near Jakarta. Central Java has had 11 cases and ten deaths. especially those from the international community. Vaccination. solves the problem in theory. unwashed eggs. aged one and eight. almost no conception of it at all”122. the capital Jakarta. Given Indonesia’s geography. and constructions and 120 121 Interview. movement controls are not going to reach the required standards soon either. Jakarta 26 August 2008 Interview. Bogor 21 August 2008 122 Interview.

Adult deaths divide into roughly equal numbers of males and females. It is not just with respect to avian influenza that the medical community is faced with uphill work. Forty-one case patients (76%) had had direct or indirect contact with poultry during the preceding two weeks. defeathering. informant made the comment on the popular understanding of germ theory. which began this section. suggesting a possible genetic susceptibility. 124 125 Interview. and consuming raw or undercooked poultry or poultry products have all been implicated in transmission. realise what the consequences of a pandemic will be. Chickens are everywhere. which has had a remarkable number of cases. But you walk between the tower blocks and you find a village with live markets. of which 54 were confirmed and 41 fatal: a case-fatality proportion of 76%. even chickens scratching around. wetter months. and a high level of traffic movements in and out of the city. This is life in Indonesia. There is evidence that the virus replicates in the gastrointestinal tract and that infection is possible through ingestion of contaminated food and water (ibid). but the disease is so rare as to be barely noticeable. some very detailed work has been accomplished. In Indonesia. the Indonesian and international doctors and epidemiologists working in the MoH. there has been little to drive attention or action in the human health domain. Nevertheless. More than one third (54 cases) occurred in seven clusters among blood relatives. medically trained. handling fighting cocks and ducks that appear to be well. In my opinion. numinous notions push forwards strongly in many cultures. playing with or handling diseased or dead poultry.understandings of the danger on the ground. and handling sick or dead poultry is the most commonly recognized risk factor (WHO 2008:262). teeming life. Tangerang is the hottest spot. There is still a concentration of poultry farming and processing there. there’s a realisation that the problem has not gone away.Jakarta is better informed. Furthermore. two live market workers and one shuttlecock feather selector. so people are more likely to report. Jakarta 15 August 2008 Interview. This is possibly a surveillance artefact . the markets drive the problem in Jakarta. so interest drops off and people forget about it. immediately north-west of Jakarta. More than anyone. 53% were under 20 and 24% under ten. nose or eyes (Vong et al 2008:1304) with the virus replicating primarily in the human respiratory tract. The same. It’s very difficult to keep AI in people’s minds”125. life remains essentially unchanged. contact with fertilisers containing poultry excreta is also considered a risk factor (Lye et al 2006:472). especially in the countryside. Even in Tangerang. Slaughtering. Bird-to-human transmission is believed to occur largely by infected bird secretions being inhaled or transferred with contaminated hands to the mouth. One interviewee complained: “Cases decline in the annual dry season. and increases in human cases have been observed in the cooler. An interviewee explained: It’s obvious that human cases are concentrated very much around Jakarta and the western end of Java. If the government’s response is largely reactive. Confirmed cases ranged in age from 18 months to 45 years. Sedyaningsih et al (2007:524) investigated 598 suspected cases in Indonesia between July 2005 and June 2006. and better off. especially for a relatively poor and relatively unprepared country like Indonesia. Jakarta 12 August 2008 38 . not just in Indonesia. or preparing sick poultry for cooking. An analysis of 340 cases globally to 14 December 2007 found that direct avian-to-human virus transmission is the predominant means of infection. and six case patients (11%) had poultry-related occupations. the movements of birds and people in and out of the city124. including three farm workers. concerning matters of disease and death. fatalistic. Then when cases rise again in January and February. where the population density is the highest. But they are faced with huge challenges in making the case that HPAI is an urgent problem that needs concerted effort and action at all levels.

pulmonary tuberculosis. particularly when the weather goes wrong. developing information systems. Typhoid. One interviewee. as is child under-nutrition in some regions. Serum samples can also be tested for H5N1 using H5-specific antisera. Sero-surveillance programmes and information campaigns have also been run. government spending is falling. and fell a further 38% during the years 2000-2004. and that the threat to humans is best addressed there. the country is doing all right. we wouldn’t have much to do here. providing antiviral treatment at provincial and district levels. said: “If it wasn’t for avian influenza.searo. With demand for healthcare increasing due to economic growth. diarrhoeal diseases. 170 District Surveillance Officers in nine provinces had been trained and equipped126. supported by the WHO and donors that include USAID. shortness of breath and cough. which WHO suggests is $33 per capita (in US dollars) and $118 (in 126 127 USAID CBAIC Avian Influenza Roundup Issue 2 April 2008 Interview. urbanisation and ageing. but Lye et al (2006:472) suggest that the results have been ‘almost uniformly unhelpful’.13129 and the World Bank currently considers Indonesia’s health spending to be ‘low’ at less than 3% of GDP130. Except perhaps on the eastern islands. Jakarta 13 August 2008 128 Interview. Those involved. on both the medical and agricultural sides. difficult questions of priorities inevitably arise. It’s feeding people and going forwards” pneumonia and HIV/AIDS are prevalent.who. An international veterinarian agreed. see Viral sovereignty. providing personal protection equipment for health workers. Testing involves confirming viral RNA in throat swabs. It is accepted that Indonesia made substantial improvements in health care in the 1970s and 1980s (Kristiansen and Santoso 2006). By the end of 2007. this number is miniscule. below) usually the University of Hong Kong or the US Centers for Disease Control and Prevention (CDC) in Atlanta. training health care workers. aimed at market and poultry workers particularly. but WHO confirmation requires samples to be tested in a WHO reference lab. and establishing a command post in the ministry. These tests are available in Indonesia. however. According to Kristiansen and Santoso (2006:249) spending on primary health care reduced by 25% per capita between 1996/1997 and 1999/2000. The number of medical doctors to 1. The most common symptoms are fever. But with respect to human health. which for Indonesia is (or was. Bogor 20 August 2008 129 WHO – ‘11 health questions about the 11 SEAR countries’ available at http://www. commenting on the involvement of the international community more broadly in Indonesian agricultural affairs. but H5N1 is doubtlessly putting a further strain on an already stretched system. AusAID and the government of Japan. tetanus and rabies are continuing problems. citing the spread of rabies as the only other significant zoonotic threat currently facing the country128. with pneumonia showing on chest radiograph. has responded by designating 44 hospitals nationwide (previously SARS centres) as specialist H5N1 referral centres.The fact remains that H5N1 is a very rare disease in humans (Sedyaningsih et al 2007:527). Rapid antigen tests are also used. MoH launched a community level initiative focusing on 12. building laboratory capacity (currently there are two labs in the country with BSL-3 capacity). would say that the virus is most prevalent in poultry. Compared with the numbers trained to recognise and respond to the disease in chickens.000 remote villages. and significant outbreaks of Dengue Haemorrhagic Fever occurred in 2004 and poliomyelitis in 2005. In November 2006. The Ministry of Health. endotracheal aspirates and lung biopsy samples (from the deceased) by conventional or real time reverse-transcriptase polymerase chain reaction (RT-PCR). and in April 2007 the Integrated Surveillance for Avian Influenza (ISAI) Project was launched linking human surveillance with animal surveillance through collaboration with MoA and FAO. It is also difficult to diagnose and confirm.000 people is the lowest in the region at 0. Malaria.pdf accessed 9 November 2008 130 Indonesia: Economic and Social update World Bank April 2008 39 .

131 132 An international dollar has the same purchasing power as the US dollar has in the US. In 2005. social and geographic disparities in access to. The healthcare system is also in the middle of a major transformation characterised by what has been described as contradictory trends in which centralization co-exists with decentralization and strong state control parallels market-driven healthcare (Ramesh and Wu 2008:174 citing WHO 2004). In other likely cases. Jakarta Post 17/07/07 133 One treatment course of Oseltamivir (10x75mg tablets) costs $15 even at discount rates. suggest that the designated referral hospitals are now reasonably well equipped to deal with sporadic cases. In some areas treatment of human H5N1 infection is reputed to be free134. specimens have not been available for testing. and sometimes they are used as excuses to cut corners. The variability of influenza viruses calls for frequent updating of primers and probes and that doesn’t always happen. and late initiation of therapy appears to be a major factor in the high mortality rate (WHO 2008:268). Nevertheless. grow the virus and test at a genomic dollars131). They have isolation facilities.33 million. occupational health and safety. but as an interviewee explained. health services are considered to be on the increase. If anyone of any significant financial means became ill with the disease. and public hospitals charge fees based on the class of accommodation. About 15% of the population are covered by private health insurance schemes and 21% by public programmes (Kristiansen and Santoso 2006:250). there are labs that can detect the disease. Staff are trained in technical specifics. and what it should constitute. or approximately $2. Since 2001.4 per person133. You are never sure about quality control136. with about two thirds of total health expenditure coming out of pocket (Ramesh and Wu 2008:174). The non-specific clinical presentation of H5N1 has also resulted in mis-diagnosis of subsequently confirmed cases (WHO 2008). The private sector accounts for 67% of all hospitals. informants familiar with the Indonesian health system. Public health clinics (puskesmas) and family planning clinics are free. they would quickly be in hospital and receiving care. and I’ve seen work I can only describe as sloppy. Similarly. Jakarta 28 August 2008 136 Interview. avian influenza has been a disease of the poor and either the rural. One said: The hospitals are getting better. and very different pictures between the different strata of society as to the availability of medical care. managerial and financial responsibilities for public health care have been decentralized from central government to the district level. In July 2007. this does not necessarily solve the problem: “What happens if you report to hospital like a good citizen and it turns out you don’t have the disease? Do you then get a bill? There’s not much trust”135. There are no lab bees obsessed with getting it right. 134 ‘Free medication care on offer to people with flu symptoms’ Jakarta Post 14/09/2005 135 Interview. To date. and health care is increasingly privatized. but there are questions about the skills available to interpret data. There are always financial pressures. the president announced that central government had allocated Rp20 trillion ($2. protocols and drugs. Jakarta 28 August 2008 40 . especially in Jakarta. Thus there is a common reluctance among the poor to seek medical assistance due to the fear of high costs (Kristiansen and Santoso 2006:252 citing Hunter 2004).22 billion) or about 2. and the relatively high mortality rate. Despite these grim facts. with a budget allocation of US$144. and the H5N1 response.6% of the state budget for health132. and some infections have probably not been identified due to the use of unsuitable primers and probes in the RT-PCR test process. Only the more severe cases may reach medical attention (Lye et al 2006:474). the National Social Security System ( Sistem Jaminan Sosial Nasional) was launched to cover some 60 million of the poorest. This may result in under reporting of H5N1 infection. but nurses lack access to basic training – simple things like waste management. and quality of. or those living on urban peripheries.

41 . Jakarta 28 August 2008. This situation is examined in more detail in the penultimate section. particularly the style and manner of leadership in the MoH. mis-prescription and over-prescription. The ministry of health and the culture here is so slow. ticking towards their expiry dates142) and any human vaccines that might be produced in the months following the outbreak of a human epidemic. the most salient facts are that Indonesia is totally dependent on the international community for the provision of front line anti-viral drugs (of which some stocks exist in the country. There is often what I can only describe as a mystical approach138. Jakarta 12 August 2008 142 Kompas (11/12/08) reports that 7 million ‘doses’ of Tamiflu worth Rp200 billion were due to expire in January 2009. for example. Jakarta 15 August 2008 139 Interview. as if that is going to fix the problem. All agree however that real world politics. But here research raises a red flag in the ministry. Viruses and sovereignty. The Karo cluster is also noteworthy as a situation where the local population did not see national or local governments as legitimate sources of information. civil servants. Jakarta 28 August 2008 141 Interview. resulting in the Bogor Agriculture Institute (IPB) and the WHO being called in (Padmawati and Nichter 2008: 43). Jakarta 12 August 2008 Interview. and the countries that don’t have many cases are not inclined to do the work. Others with the disease who do get to hospital decide to go home for no reason other than they want to. Here the scientists are the designers and they usually don’t have much idea about what is going to work in the real world141. 140 Interview. One focuses on the need for more pure research. There is no sense of urgency at all” 137. In other countries. Karo. capacity building and skill-set improvement. as far as H5N1 is concerned. A medically qualified interviewee suggested: In the medical sphere there’s too much emphasis on lab capacity strengthening and analysing the virus. or 137 138 Interview. The other focuses more on the need for organizational change. One respondent suggested: “There is no shortage of funds for AI but it is hard to spend the money because the baseline is so low. Changing these circumstances will be the work of years. The medical community falls into two (not uncomplimentary) camps. It’s so sensitive140. Yet detection of H5N1 in humans is rated as reasonable. is a very remote area. As things stand. public health experts. I’ve seen misdiagnosis. What this means is that flu patients might get to hospital on day four or day six and are told that they have dengue and are sent home. however. Another spoke of poor medical understanding: Sometimes Indonesian doctors leave me aghast at their decision-making. An interviewee said: “Sure. but the second case there in 2006 was detected”139. An interviewee said: A lot of research is needed. there are sporadic deaths that are not investigated – like any disease – but I’d say that there is now the capacity to detect clusters. Oshitani at al (2008) argue that developing countries will probably be more badly affected by a pandemic than industrialised countries.Others stress the low capacity and poor adaptability of the health system. have intervened in the medical response and made basic and important medical work more difficult. if not impossible. What is going on with the clusters of blood relatives? Why are more poultry workers not catching the disease? How is the virus changing? The fact is that the countries where cases are occurring rarely have the capacity to do this work. managers have all made useful inputs.

Not all activities are centrally monitored or funded. Indonesia. Despite the fatalistic nature of the culture. They are all challenged by attitudes that see regular poultry deaths as normal and unavoidable. The challenge is to encourage the communities to understand what is going on and be responsible”144.decades143. and other government ministries. provincial and district levels. led by KOMNAS FBPI. This is the subject of the next section. and few have yet forgotten the death and devastation caused by the Indian Ocean tsunami at the end of 2004. DAI counted around 25.5m each to six manufacturers from Brazil. Jakarta 12 August 2008 42 . who give the impression that they are simply keeping their heads down and trying to get some work done. One respondent said: “There are literally hundreds of activities. It operates in three main spheres. this involves increasing awareness of the virus and its potential consequences amongst the population. (DAI). DAI’s USAID-funded Community-Based Avian Influenza Control (CBAIC) project was launched in July 2006. about a third of the birds are eaten. See http://www. training government spokespeople. promoting community-based disease surveillance. 143 On 24 April 2007. There is also a well-founded appreciation in the medical community that H5N1 is best dealt with before it infects humans. and the involvement and activities of local organizations such as Muhammadiyah. There’s no demand from the population to discover why. This is the way it always has been. On Bali for example. and building local subcontractor capacity. videos. were seen as significant successes in broadening the scope and the appeal of the communications response. the individuals and organizations dealing with such future-leaning aspects of the response as pandemic planning and emergency preparedness may actually be having an easier time than the international medical community. and a third die. Natural disasters hit Indonesia regularly. national. a third are used in ceremonies. regional and other international groups. A wide range of organizations are involved in public communications and information initiatives. but UNICEF leans more to addressing the disease in humans. and attempting to change behaviour that puts people at risk. even the doctors most determined to have some influence in the H5N1 response realise that a utilitarian public good. WHO approved initial grants of $2. to strengthen pandemic preparedness at national. This involves running events and training workshops. working with government. and Vietnam to establish production capacity for flu vaccines. This involves facilitating meetings to improve coordination within and between the relevant ministries and local government offices. or diarrhoeal diseases. and faced with the low capacity and competing priorities associated with health care. AGITATING FOR CHANGE “A dead chicken is a dead chicken. The second sphere is more local: managing and coordinating community mobilization and training. and the Indonesian Red Cross. as illustrated by the comment above. India. Thailand. Mexico. But they are fragmented and this means they are less effective”145. Inc. posters and stickers. One links with KOMNAS. and drafting and producing leaflets and other communications material. most certainly one with a national perspective. dengue fever. which are focused on raising awareness and spreading information about how to recognize the disease and stop its spread. banners. T-shirts. and DAI to addressing the disease in accessed 5 October 2008 144 Interview.000 volunteers trained to recognize HPAI symptoms and respond to outbreaks. Avian mortality is just not an issue. The third. nearly all of which are useful. rather than the threat of an influenza pandemic. Broad objectives include supporting community planning and mobilization. and producing a wide range of materials including booklets. would focus on TB. Jakarta 13 August 2008 145 Interview. As well as attacking the disease in animals. one of the country’s biggest Muslim groups. for example. By mid-2008.bmj. UNICEF and Development Alternatives. calendars. run the largest projects. There is significant cross over.

Professional groups such as the Hotel & Restaurant Association have also been engaged and UN system organizations not seen as central to the avian influenza response have been active. 146 147 Interview. Looking to 2009.000 schools across Indonesia. a student group was sponsored by the Ministry of Agriculture to travel around the country spreading a poultry hygiene message and encouraging people to eat chicken. In West Java. the ‘Take Action’ campaign was expanded with a social mobilization and education programme that involved distributing 1. In addition to these mass media and grass roots campaigns. soap. Jakarta 15 August 2008 Jakarta Post 7/06/07 43 . sphere of activity (in partnership with the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs) is to develop and implement a range of behaviour change communication programmes. launched a national awareness raising campaign called ‘Tanggap Flu Burung’ (‘Take Action on Bird Flu’). with partners. These 30-second TV spots were dramatic and hard hitting – dead chickens. UNICEF also supports media relations and communications at KOMNAS FBPI. an instructional booklet and video compact discs. UNICEF has implemented a related child-orientated programme that includes games. human deaths – with the messages of burn and bury infected chickens and report the incident. drumming and dances. South Sulawesi for a celebrity pop concert). and distribute a booklet for religious leaders146. The campaign’s keystone was a memorable thumbs-up hand symbol with four key messages on the fingers: don’t touch sick or dying birds.000 people together in Gowa. The most recent and prominent of these was a series of nationwide television and radio public service announcements (PSAs). hospitals. a Sundanese performance group has produced the Flu Burung Longser Show. In September 2006. banners. UNICEF. The school kits include a comic book and other material using the characters of a popular television show. especially after contact with birds. to community leaders in some 100. plan to replicate a project run in Thailand promoting good workplace practice in the commercial poultry sector. and working closely with KOMNAS. which ran from January to April 2008. This blizzard of activity has been very successful in raising general awareness.overlapping. Bali. South Sulawesi. Aceh. and the production and distribution of leaflets and other materials. alarms. stickers. UNESCO. Aside from this centrally coordinated activity. separate new birds from the flock for two weeks. a comic opera using songs. and teachers are being encouraged to incorporate avian influenza related material into the curriculum. parades and health walks have been initiated by all sorts of independent groups. for example. with smaller-scale programmes running in Papua.000 villages in high-risk areas. and conducts avian influenza related training for journalists. and report flu-like symptoms and seek medical attention. and this is now being extended to over 50. The focus is on Java. for example. In May 2007. The campaign included public concerts (one notable event in October 2006 brought more than 10. and four provinces in Sumatra. a wide range of events including rallies. wash your hands before eating and cook poultry well. KOMNAS data show that 97% of Indonesians are aware of avian influenza. In December 2006. gloves. produce a new set of public service announcements. The broad objective was to raise the level of perceived threat of human disease amongst the general population. with funding from the government of Japan.200 avian flu kits. is involved with the same group in developing pandemic preparedness planning. The International Labour Organization (ILO) and the International Union of Food Workers (IUF). Most prominent however was a four-month radio and television campaign consisting of four light-hearted 30-second spots (one for each of the four key messages) introduced by a wellknown talk-show host. and East Nusatenggara provinces. has been distributing poultry cages and running workshops on Bali. billboards. but only 15% regard it as a direct threat to themselves and their families147. Maluku. More recently. UNICEF plans to roll out a radio drama series. but has not yet had time to show convincing behaviour change. an animated film and television advertisements. containing masks.

The next stage must go beyond the media and confront people face-to-face. but little on long-term behaviour. people are not on the alert. We have to keep reminding people. Jakarta 21 August 2008 150 Interview. There is a tradition of authoritarian central control. from poultry had to find another job. community leaders. But this was only for three months and there was opposition in the press. are vital148. The middle classes and the rich stood aside. and people tend to forget. Around 40% . the capital. The question is not just how to change habits. The relationship between humans and the environment is key. One of the greatest challenges for avian influenza communications in Indonesia is that there are so many different regions. A respondent suggested: The usual idea with communications programmes is that you have one clear message. Some did. they can take the message to the community149. That’s possible in Jakarta. cultures and groups involved. If you don’t have one message you risk confusing people. This made the government reluctant to go forwards. If they believe you. other activities associated with the response have had powerful short-term effects on awareness. You have to get the leaders to trust you first. Constant communications. but how to change the way people live. It has proved difficult however to win public backing. and changes in behaviour and practices are less than optimal. But here we need different messages for different groups. Others just moved 148 149 Interview. One interviewee explained: In the first few months there were cullings. This was not their concern. Democracy has a price. and moves were announced to move poultry markets and abattoirs out of residential areas151.60% of people who were making a living. and a very long tradition of people living close to animals. That’s not easy150. or part of their living. They were on TV. year after year. with most speaking of avian influenza as some form of tetelo (Newcastle disease). Those with flocks of five to 500 were hardest hit. When human cases decrease. In Jakarta. but it won’t solve the problem. You can’t change this sort of thing overnight. religious leaders. backyard birds were banned in January 2007. Reporting concentrated on the concerns of low-income poultry farmers. What was feared more than illness was loosing chickens due to culling. Jakarta 12 August 2008 151 Jakarta Post 30/01/07 152 Interview. We need deeper reflection.Padmawati and Nichter (2008) found no farmers who expressed personal fear of avian influenza. It is that the scale of priorities has been compromised152. Washing your hands before eating might save you. Aside from targeted communications. or the price of chicken falling. How do you reach cock-fighters and housewives with the same message? How do you communicate both with those who live in modern air-conditioned apartments and with those who live in communal longhouses with no taps or toilets? It’s impossible. The community is only at the level of knowing. Another informant said: There was a 50% price drop following the announcement. They key is trust and this is hard. Jakarta 25 August 2008 44 . Another said: Culturally it’s very complicated. One informant explained: The awareness among at risk groups is quite high but the perception of the risk is low. particularly chickens. Bogor 20 August 2008 Interview.

Jakarta 15 August 2008. suggesting that individuals and groups with different world views will have different risk accessed 1 November 2008 45 . Krakatoa and Tambora. and in a number of instances. became famous worldwide for their devastating eruptions. There was disinfectant.their little farms from around their houses to unoccupied land nearby. What one sees depends on where one stands. Social organizations will emphasize the risks that hold the group together. agriculture was actually being expanded upslope into more dangerous areas. Geneva and Rome) and the villages of western Java. 153 Interview. It showed that this country is not the basket case most people make it out to be. social structures and values all differ radically between Washington DC (or London. Studying three highly volcanic areas on Java – Sumbing/Sindoro.emdat. Lavigne et al conclude that local people often underestimate the scientifically or statistically estimated risk. or the low-rise sprawl of Jakarta’s periphery. The EM-DAT database156 identifies 130 active volcanoes in the country and lists 39 deadly eruptions in the last century. as well as the strong sense of fatalism in society. 97% of those surveyed thought eruptions were an admonition from the supernatural world and did not see death as a negative event. everybody seemed to have forgotten about it. Roles and responsibilities had been defined. In the 19th century. drugs. An attendee said: I was very impressed. Common values lead to common fears. But the question left hanging in my mind was: how do you contain panicking people without the army using their guns?155 A comparison might be made between avian influenza and the threat of volcanic eruption. which is significant in Indonesia.000 people in Jembrana regency in Bali154. Jakarta 12 August 2008 156 Available at http://www. poor people’s incomes dropped by one third. Douglas (1992) concurred from a more anthropological perspective: different societies fear different sorts of threats which correlate with differences in social structure. Wildavsky (1979) posited both the environment and risk as social constructs. Another high-profile event was a three-day pandemic simulation involving nearly 1. Things worked. and the weak Indonesian conception of a national public good (let alone one that links Indonesia with the rest of the world). and you still see and hear birds in the city153. Coupled with the disconnect that exists between the international response. World views. This cultural theory holds that people value things they participate in or identify with. most significantly by the global public good associated with preventing a human influenza pandemic. transport. there is a significant disconnect between the global construction of the risk associated with H5N1. which is driven. food. and the Indonesian one. These attitudes to the risk of volcanic eruption show similarities to those amongst the rural population in particular with respect to H5N1. so it is inevitable that there are going to be radically different constructions of risk associated not just with H5N1. and funded. and that the perceived risk was very dependent on whether the volcano could be seen. The wet markets were seriously affected for about six months. but almost everything. If Indonesians have been living with chickens for centuries. Now you see live birds being sold again. just two or three days later. Then. A detailed assessment of the impact of the Jakarta ban is available: ‘Livelihood and Gender Impact of Rapid Changes to Bio-Security Policy in the Jakarta Area and Lessons Learned for Future Approaches in Urban Areas’ ICASEPS & FAO (2008). it was back to normality. Nobody in the nearby communities was afraid of volcanic eruption. and suggests a functionalist explanation: social structures generate attitudes that serve to uphold the social structure. 154 Jakarta Post 26/04/08 155 Interview. The bottom line is that poultry numbers halved. Around Merapi. Rather it was a regenerative process that should be accepted with human humility. they have been living with volcanoes for longer. Dieng and Merapi – Lavigne et al (2008) found only a few people aware of the volcanic threat.

fao. construct risks in widely varying ways. especially a global one. and the global community was quick to respond. the rich and the poor. is working out what has had the most effect. in Indonesia’s stratified society. Another was the Convention on Biological Diversity. children can be more easily encouraged. Whose risks are really being addressed. See http://www. and why? Another difficulty emerging from the number. shockwaves are still rippling through the international health. and the response. Timely samples are vital to track changes in the virus. It would only resume if the system were changed to give Indonesia control over where viruses originating from Indonesia went. Two years later. Supari was insisting on a Material Transfer Agreement (MTA) that recognised the viruses as Indonesian. the urban and the accessed 8 November 2008 158 See Garrett and Fidler (2007) for example. especially concerning the thorny and important matter of provoking long-lasting behaviour change. In risk communications.htm accessed 1 November 2008 160 See: http://www. This smacked too much of ‘charity’ to Supari (ibid:33). and a share of profits resulting from research and commercialisation.who. These themes coalesce in the geo-political storm which began on 20 December 2006. A more public series of events followed. such as Muhammadiyah and the Hotel & Restaurant Association. to see that they have commonalities. and after seven hours of negotiations (with much energy apparently expended in trying to make Supari’s notion of ‘empowerment’ meet the WHO’s notion of ‘capacity building’). offering anti-viral drug and vaccine supplies. Which common values are going to lead to which common fears? Which groups are to be held together by commonly constructed risks? This makes the communications aspects of the response particularly challenging. Jasanoff 1982. and so start closer to the position of sharing common constructions of the risk.twnside. Dr Siti Fadilah Supari. In mid-February 2007. as a first step. and Irwin and Wynn 1996). when Indonesia’s minister of health. Similarly. decided that the country would stop sending human H5N1 virus samples to the WHO as long as it followed the ‘imperialist’ GISN 157 mechanism (Supari 2008:24). and support for developing laboratory and vaccine manufacturing facilities. and the WHO was required to “establish the mechanisms for more open virus and information sharing and accessibility to avian influenza and other potential pandemic influenza vaccines for developing countries”. two ‘high level’ meetings were convened in accessed 5 November 2008 46 . They share common values. scale and range of the internationally led communications initiatives. which recognizes the sovereign right of states over genetic resources160. or ‘'Sovereignty' That Risks Global Health’ by Richard Holbrooke and Laurie Garrett (Washington Post 10/08/08). VIRUSES AND SOVEREIGNTY The previous sections have shown how the response to HPAI in Indonesia has been hampered by political and bureaucratic processes. diplomatic and academic communities158. WHO representatives met with Supari and her team in Jakarta. and are less dependent on existing values and routines. for example. In late March. the matter remained and the people who are being affected by the disease. Fidler (2008). however. 159 See: http://www. which included 13 ministers from ‘like-minded’ countries. trust above all is As previously discussed this is lacking at many levels in Indonesia. Here the greatest value may be found in involving cohesive groups. the lack of a coherent idea of a public good. and resulted in the ‘Jakarta 157 Since 1952 the WHO Global Influenza Surveillance Network (GISN) has monitored evolving viruses and made twice yearly recommendations for the formulation of seasonal influenza vaccines. and many other groups. and significantly different constructions of risk associated with the international organizations which are driving the response.Furthermore. Wynne 1992. especially trust in the institutions behind the messages (cf. One model was the International Treaty on Plant Genetic Resources159.

“The conspiracy between superpower nations and global organizations is a reality. Saatnya Dunia Berubah Tangan Tuhan di Balik Flu Burung. Vietnam. and three samples released. held in conjunction with the WHA. tense negotiations continued at an intergovernmental meeting in Geneva. during 2008 Supari has remained robustly unswayed. and deaths. Supari appointed Baxter to develop a vaccine from the Indonesian strain. and staff from PT Biofarma. and at the first Non-Aligned Movement Health Ministers’ Meeting. 47 . NAMRU-2 provided confirmation of all human cases of H5N1 in Indonesia from June 2005 to January 2007. she learnt that Australiabased CSL Ltd. Supari has accused the WHO of colluding with rich world pharmaceutical companies to trick poor nations into giving away virus samples. 165 Interview. In the same month. to be processed into drugs and vaccines that are then denied to countries that can’t afford them.who. and at the international ministerial conference on avian and pandemic influenza in Delhi. Despite an international diplomatic offensive.france24. In February 2007. gets infected. but it’s something I’ve experienced myself”163. and questions emerge which are almost philosophical. would no longer be reported on a case-bycase basis to the press.who. “It isn’t a theory. The resolution received support from 24 countries including Iran. In mid-April. 112 countries voiced their concern at existing arrangements. but I’d say the problem boils down to a poor understanding of the issues. but Supari has overplayed her hand. In April she made charges of spying against Jakarta-based US Naval Medical Research Unit Two (NAMRU-2)162 and in May.Declaration’161. promoting their vaccine production capability and offering a human vaccine developed from a Vietnamese strain. at the end of 2005. North Korea. a large number of people are certain never to see any vaccine in any circumstances. which she accused CLS of ‘stealing’. Jakarta 28 August 2008 166 According to Supari (2008:25). and a total population of over six billion.pdf accessed 3 November 2008 Although not an official WHO collaborating centre. Supari elected to the WHO executive board. 163 AFP News Briefs 13/10/2008 available at https://bart.28. Throughout. say. Iraq. she announced that H5N1 human cases. An interviewee asked: Even if you accept that the virus is Indonesian. first visited her. isn’t rhetoric. She was instructed by the president to buy a stockpile of drugs. Divine Hand behind Avian Influenza’.com/en/20081013-indonesias-bird-fluwarrior-takes-world accessed 20 October 2008 164 See ‘A summary of tracking avian influenza A(H5N1) specimens and viruses shared with WHO from 2003 to 2007’ available at http://www. There are some tricky issues at the root of the matter. February saw the publication of her book. civil groups from around 50 Asian and African countries announced the ‘Bandung Message’ from a meeting in West Java. and in November and December. With global (seasonal influenza) vaccine production capacity currently running at no more than 500 million doses annually. and goes home? Does the virus then become Australian? Or does it even become the personal property of the patient? It is an impossible matter to wrap up legally165. Another respondent said: Everyone agrees with the basic point. but didn’t have the money. In June.” she is quoted as saying. at public meetings. Her motivation is a mystery. a meeting in Geneva ended deadlocked. the state-owned pharmaceutical company. So she’s scratching her head when Indonesian viruses start turning up in prototype vaccines 166 and 161 162 Available at http://www. representatives of Baxter International Inc. what happens if an in English: ‘It’s Time for the World to Change.pdf accessed 5 November 2008 for example. but the 60th World Health Assembly (WHA) in May saw the ‘Jakarta Declaration’ included as resolution 60. There are also doubts as to whether the virus actually originates from Indonesia. Cuba and Myanmar. Few in the international community fail to accept that Supari has raised an important matter that needs addressing. had developed a vaccine based on the Indonesian strain. but her intransigence in the face of increased global transparency164 and genuine offers of support has caused an unusual mixture of hurt and confusion.

under Sukarno. The main tension in the country is now between Islamic nationalism and secular nationalism. Citing Weinstein (1971). verging on paranoia. With spirit burning in my chest. profess to be mystified by her persistence. That means that she must not be seen to be pushed around. Indonesia. I’d say that she is also looking to deflect attention from her failures. Other analysts see a wider agenda. Sri Mulyani Indrawati. 172 Interview. 2009 is election year and there are rumours that she’s looking for the vice president position. Jakarta 14 August 2008 171 Finance minister. Or it might have been because she is not a member of any political party. It’s not difficult to work through her logic168. It’s sad. She has to drive it through. Some say that she is a friend of SBY’s wife. Jakarta 28 August 2008 169 In 1965. the first President of the Republic of Indonesia. Supari is winning over the masses. powerful’ and essentially unsympathetic to Indonesian interests. Maybe she was useful to fill a quota of four women in the cabinet. and it’s pushing to extremes. Bismillaahi rahmaanir rahiim! (ibid:25). and Siti is trying to play both cards. Jakarta 21 August 2008 48 . Nevertheless. “Ever onward. which would not have done her any harm. the whole matter is driven by nationalism. and is reputed to be associated with groups such as Hizbut Tahrir. Jakarta 15 August 2008 Interview. continues to enjoy broad support.” as Soekarno. Elson (2008:53) offers a detailed exposition of the complexities of Indonesian nationalism. no retreat. 170 Interview. Another respondent suggested: “You need a psychologist’s analysis maybe. Lifestyle magazines profile her as a ‘hero’ of Indonesia. claiming divine guidance. Alternatively. either. the elections might mean the end of the problem170. asking: 167 168 Interview. and the weekly television programme which she hosts (and sponsors) is popular viewing. however. he suggests that a long-established view of the international realm as ‘distant. and trade minister. which fits the situation well: an ongoing project characterised by ‘a confused and unproductive tension between leaders’ assumed roles as popular agents of their people’s drive towards modernity and their desire to retain or restore what they see as essentially “Indonesian”’. are both widely regarded as highly competent and effective. In any case. and not just with avian influenza. Supari has also put her Islamic faith at the centre of her struggle. Supari’s own writings back this up: For a second time169 Indonesia would lead other developing countries. One interviewee suggested: In case it’s not obvious. I determined not to step backwards. Informed Indonesians. The explanations are not necessarily rational”172. was the first country ever to withdraw from the United Nations Organization. which for a long time had been the victims of the greediness of the people of developed countries in the field of health. It’s not an easy problem and she should not take it personally167.she thinks ‘Bingo!’ Now she’s dug herself into a hole and she’s turned it into a bigger crusade. A cardiologist before being selected in 2004. put it. The nationalists are getting more strident. Supari “came from nowhere” according to one interviewee: Her appointment was a surprise. Speculatively. unreliable. which believes in replacing Indonesia's secular government with a Muslim caliphate. but she might see herself as being in competition with some of the other women in the cabinet171. Mari Pangestu.

Jakarta 11 August 2008 175 Interview. Yet again the rational. Jakarta 15 August 2008 176 Interview. and it is easy to see unfashionable nationalistic narratives in the debate as well as more fashionable pro-South ones. How do you negotiate with someone who does not know what they want?”173 Others see a simple logic at play: “This is a very quid pro quo culture. no one is prepared. No matter what the logic might be. Few would disagree that the system did not need revising to give poor and middle-income countries more say. and cross border disease control. social and cultural context. Similarly. has economic value. This debate over the ‘nationality’ of a virus has provoked unprecedented passion. It’s insane175.who. technical and universalist solutions of the 21st century global community come unstuck in the Indonesian political. and better access to affordable medicine. on both the Indonesian side and that of the organizations charged with responsibility for global health. But Supari has seen first-hand the move away from a paternalistic conception of power in her own country to a noisy sort of anarcho-democracy. The consequences for the health of the world. The ministry is not happy with WHO and WHO is not happy with the ministry. 49 . and Fidler and Gostin (2006) for an analysis accessed 10 November 2008.“Indonesia does not have stated objectives. Yet. CONCLUSION “Unless we are all prepared. Just ‘equity’. the consequences for the health of the Indonesian people. economic. pull the troops [vets. More worryingly. it also appears that religious disjuncture is being exploited. medics. We can’t even get agreements signed to disburse money we have waiting. communications people] out. according to one informant: Everything is bogged down. Nothing is moving. point a satellite at the country. few would disagree that Supari’s actions are reprehensible if motivated purely by personal political ambition. We talk to our friends and colleagues in the hierarchy and they apologise saying there is ‘anti-western sentiment’ at the top. The international response to Severe Acquired Respiratory Syndrome (SARS) in 2003 was seen as an almost ideal model of global cooperation and coordinated action to bring a new and dangerous disease under In one case we have been waiting over a year. are not yet known. But let’s say their patience runs out and they [the international community] decide to play hard ball. and despair.pdf for an outline of IHR 2005. and is looking to milk it”174. cooperation. Indonesia has thrown this optimistic new world order in doubt. and watch the virus kill every chicken in the country. agronomists. and she is doing little more than reproducing this shift on the world’s stage. where everything is negotiated. Similarly. Jakarta 14 August 2008 Interview. Another interviewee paints a blacker picture: Everyone has been polite so far because she has a fair point.” 173 174 Interview. and then start taking the children176.wpro. Siti realises that the threat of widespread avian influenza. and more importantly for Supari. or worse a human pandemic. despite signing up to IHR 2005. the new International Health Regulations (2005)177 (which were actually implemented early by some countries in response to H5N1) were seen by many as a breakthrough in global understanding. They turn the money taps off. Jakarta 22 August 2008 177 See: http://www.

26 October 2008 182 See http://www. Egypt. Istituto Zooprofilattico Sperimentale delle Venezie. or culled to prevent its spread180.pdf and http://www.3%) were zoonoses – diseases resulting from pathogens transmitted from animals to humans (Jones et al 2008:990). just eight countries were responsible for 90% of outbreaks178. Between 2006 and Indonesia. Such zoonotic Emerging Infectious Diseases (EIDs) include Marburg and Ebola hemorrhagic fevers. The free-ranging ducks and paddy (rice) fields that have been implicated in studies of HPAI in other South East Asian countries (cf. where a growing population lives in increasingly densely inhabited areas in conditions that have major consequences for trans-species virus transfers (cf. USAID. Sharm el-Sheikh.onehealthinitiative.php accessed 14 March 2008 180 Charles Lambert. but a remarkably dense population living closely with a remarkable number of poultry.oneworldonehealth. greater funding. 25-26 October 2008. and in 2008.oie. All accessed 12 December 2008 183 Interviews. Presentation at Sixth International Ministerial Conference on Avian and Pandemic Influenza. geography. As yet. but also an invaluable example of one of the greatest threats facing humankind. makes the response a severe challenge. Nipah virus encephalitis. the number of countries reporting H5N1 reduced from 53 to 19. Assistant Administrator for the Bureau for Global Health. and HIV/AIDS. SARS. Also http://www. This has resulted in an unprecedented gathering of global forces around the ‘One World One Health’ concept182. HPAI is not only “one of the most devastating animal diseases in the world”181. Deputy Under Secretary. The 1968-69 event resulted in over 700. a high level review. with only 20 outbreaks reported between 1959 and 2003 (caused by H5N1 and other subtypes of the virus)179. Sharm el-Sheikh. Bloom et al 2007). Since then there have been an uncountable number of outbreaks. Before 2003. politics. into a form that transmits between humans. held in Sharm elSheikh. and some valuable local successes. environmental and technological change. At the Sixth International Ministerial Conference on Avian and Pandemic Influenza. Head of Virology Department.000 deaths (WHO 2005). Disease ecology is entwined with social. and despite a greater effort than anywhere in the world. particularly western Java and the area around the capital. has been identified as a major ‘hot zone’ due to the massive growth in pig. Glinski and Kostro (2005) suggest that 75% of future epidemics will result from zoonoses. The opportunity presents to build on the H5N1 response to encompass other diseases at the humananimal interface. Many factors – size. USDA. 26 October 2008 181 Ilaria Capua. Sharm el-Sheikh. In Indonesia there is little scope for the ‘fatigue’ reported elsewhere183. Jakarta.5bn of the estimated 18bn poultry birds in the world have been killed by the disease. the disease is still widespread. and socio-economics – conspire against the control of HPAI in Indonesia. Gilbert et al 2008) are also present. identified seven factors as crucial to success in responding to the 178 Kent Hill. Jones et al (2008) suggest that EID origins are significantly correlated with socio-economic as well environmental and ecological factors.medicalnewstoday. South East Asia. Lassa fever. fowl and other domestic animal populations in the last 25 years. Presentation at Sixth International Ministerial Conference on Avian and Pandemic Influenza. Presentation at Sixth International Ministerial Conference on Avian and Pandemic Influenza. and other birds. focusing on the animalhuman-ecosystems interface. but other subtypes of the virus caused at least two of the last century’s three major influenza pandemics. 335 new infectious diseases emerged globally. which is occurring at an increasing rate. for the origins of this concept. Between 1940 and 2004. HPAI was In these circumstances. 26 October 2008 179 See http://www. over half of which ( as examples of the collaboration it has inspired.The globally driven response to highly pathogenic avian influenza (H5N1) has seen some tremendous successes. Sharm el-Sheikh 25 October 2008 50 . prefaced by the observation quoted at the beginning of this section. particularly in developing countries. and roughly 2. offers a prime example of these conditions. in particular. or reassorted. H5N1 has not mutated. and in 2005 the World Bank estimated that an influenza pandemic would cost the world economy around US$800 billion (World Bank 2005).

or emergent form. A simplified actor network diagram is presented in Appendix E. and the rational. The second. and the seventh. and all levels of government suffer from the wider conceptual challenges given below. and the stigma and unwelcome attention of owning them. product development and technology transfer. This paper has indicated that Indonesia is challenged in all these areas. Paris and Washington – that such does. the national government is not committed to eradicating the disease. 25 October 2008 185 Interviews. bureaucratic response based on surveillance.disease184. with improved management of veterinary and medical services. the private sector. According to Rosen (1993:215) cited in Wald (2008:17) epidemics indicate the need for regulation with “terrifying urgency” and set in motion “the administrative machinery for disease prevention. and transparent sharing of information. Sharm el-Sheikh. The first was high level political 18 million citations ranks Indonesia’s academic output as the lowest in the region with a score of 1.ncbi.7.nih. effective strategic alliances of civil society. or emergent form. Sharm el-Sheik 27 October 2008 186 An informal analysis of PubMed’s (www. Inside 184 David Nabarro. effective strategic alliances of civil society. Regarding transparent sharing of information. as do nearly all other aspects of the response. of a modern Weberian bureaucracy. Washington 11 June 2008. and has partially been formed by it. sanitary supervision. again Indonesia starts from a low baseline186 and political wrangling emanating from the Ministry of Health has made even dialogue designed to move these elements in the right direction difficult. Europe has lived with the idea of the ‘medical police’ (Medizinischpolizei) for 250 years. and the fifth. Many other pressing priorities exist for all groups.nlm. UNSIC. sharing few commonalities. the lack. that the international community associates with acting in pursuit of a (global) public good. collective government support for mass communications on HPAI and healthy behaviour. the private sector. Incentives to encourage reporting are at best patchy given the confusion and inconsistent regimes of compensation attached to culling infected birds. as the challenges of disbursing funds into them have shown185. In actor network terms. coupled with the assumption by many in the international agencies leading the H5N1 response – mainly based in Rome.8 and Thailand at 14. then director of the US Centers for Disease Control and Prevention (CDC): “the health of the individual is best ensured by maintaining or improving the health of the entire community. and imperatives. factor underlying the challenges in Indonesia. intervention and control runs into difficulty. which are only now beginning to coalesce into the sort of networks that might yield coherent action. but such a concept really only arrived in Indonesia with the HPAI response. nor are there significant demands for this to happen from the population. 51 .” but goes on to ask: ‘what constitutes the entire community?’ In Indonesia’s dynamic young democracy.4. The sixth identified research. of such a concept in Indonesia. and the situation is complicated greatly by an ongoing process of finely grained decentralization. Geneva. or should exist. the situation is characterised by a very large number of actors. Scaling up and improving the management of veterinary and medical services in Indonesia will be the work of decades rather than years. and again. The second was the ability to scale up in key sectors. Finally. except some aspects of the last. The first is the lack. product development and technology transfer. Despite the attention of some determined and dedicated individuals.8 compared with Vietnam at 5. with effective compensation schemes. and. given as the third. is a mismatch between the clear moral right. or the poultry industry. Presentation at Sixth International Ministerial Conference on Avian and Pandemic Influenza. Malaysia at 11. The high levels of disease reported from Indonesia are due entirely to Ministry of Agriculture teams actively searching for it. and all levels of government. Paul Farmer (1996:261) quotes David Satcher (1995:3). The fourth was clear incentives to encourage reporting. the answer is far from clear. research. can. and related. given the low levels currently existing. in general. protection of community health”. Jakarta 28 August 2008. legalistic. and a weak regulatory environment. Three main conceptual factors underlie the relative failure of Indonesia to address HPAI effectively.

a paradigm of centrally planned and enacted intervention. Jasanoff 1990 and 2004. which are shaped by political and economic forces (cf. particularly bio-medicine. The narratives – the storylines – of the international organizations do not fit naturally. unified discourse. as well as trust in the individuals and institutions making prescriptions. with those that exist or are emerging nationally. and policy-makers frame scientific enquiry by defining what is relevant. and Indonesia’s context. clannish. regional. scientific experts cannot just prescribe and expect obedience. nanotechnology and even global climate change. and as yet unsympathetic to modernist models of authority and rationality. Its boundaries and competencies are drawn differently by different people. conceptual factor relates to a wider domain than H5N1 in Indonesia. Van Zwanenberg and Millstone 2005) can be seen in attitudes to nuclear power. and science. Put simply. Context. therefore matters. Given that scientists frame policy issues by defining what evidence is significant and available. and an overdeveloped understanding that there is political capital to be gained by suggesting they don’t. which can be called the political economy. industry. and to ignore this – as well as to assume a rational technocracy – risks generating uncertainty and unexpected outcomes. and generate genuine trust must be found. it is in this realm that new ways to engage civil society. an emerging mesh of power relations linking health. Furthermore. complex. Faced with such a consistent and clearly constructed threat – an invisible virus – the global response can only present as a consistent. where there is an undeveloped understanding that the people of Indonesia share commonalities with those of the rest of the world. it will ask partial questions responding to partial interests (Fairhead and Leach 2003). or necessarily. This increasingly difficult relationship between science and society (cf. history and current position in geo-politics. unhelpful self-sustaining routines of co-production can emerge. as has been shown. and most pertinent. The third. 52 . designed the response. and socially stratified conceptions of common goods exist. Stirling 1999. and defined its own terms of success and failure. if scientific knowledge is created by people and institutions with particular situated and partial perspectives. Renn 1992. create effective publicprivate partnerships. has constructed the threat. Indonesia’s young and ex-colonial national identity is so challenged by internal diversity – ethnic. Interests therefore align in a particular historical-cultural context. This is reflected in Indonesia’s international interactions.this vast. whose voices and alternative approaches may be obscured by the prominence and power of science. diverse and rapidly developing country. Given Indonesia’s diversity. cultural and socio-economic – that it has little option but to lean heavily on the idea of ‘otherness’. institutionalism and governance. especially those in industrialized countries. is diverse. genetically modified organisms. The H5N1 virus is a construction of science. Yet science’s truths are not universal. Jasanoff and Wynne 1998). complexity. but the idea that there is a good of benefit to every Indonesian finds little traction.

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FAO D. FAO P. FAO Heru Hendratmoko. FAO Ignacio Leon-Garcia. HPAI Campaign Management Unit. US Foreign Agriculture Service Emma Watkins. Particular thanks are due to Robyn Alders (FAO). Alliance of Independent Journalists Lisa Kramer. Ministry of Agriculture Jeffrey Straka. FAO François Meslin. Bimo Wicaksana. USAID Bayu Krisnamurthi. All errors and omissions remain the responsibility of the author.A. Indonesian-Dutch HPAI Partnership Suzanna Dayne. FAO Elisa Wagner. USDA Iwan Willyanto FAO Mary Young. WHO Soedjasmiran Prodjodihardjo. British Embassy Ivo Claassen. Eric Brum (FAO). James McGrane (FAO) and Piers Merrick (World Bank) who kindly commented on drafts of this paper. Ministry of Agriculture Glenn Bruce. BOGOR AND MAJALENGKA. FAO Ronello Abila. ILRI James McGrane. KOMNAS FBPI/Bogor Institute for Agriculture Elly Sawitri Siregar. Majalengka Warief Djajanto Basorie. 58 . KOMNAS FBPI Stacie Lawson.APPENDIX A: INTERVIEWEES AND RESPONDENTS. FAO Irsyad Zamjani CENAS (Centre of Asian Studies) and three people who did not wish to be named. FAO Iqbal Rafani. LPDS Edi Basuno. ICASEPS. WHO Ron Thornton. CBAIC Graham Tallis. 11 TO 28 AUGUST 2008 Serani Abeyesekera. Ministry of Agriculture Gina Samaan. OCHA Jeffrey Mariner. AusAID Jonathan Gilman. FAO Steve Leenhouts. Jakarta Piers Cazalet. Warief Djajanto Basorie (LPDS). UNICEF Lynleigh Evans.K. ICASEPS. WHO Heru Setijanto. OIE Robyn Alders. JAKARTA. Arifin.

000 (current) (2007. FITA . Indonesia has an estimated standing population of 317 million native/village WDI http://siteresources. and 7% layers.000 ( B: COMPARATIVE DATA FOR INDONESIA National facts and figures Total population Total land area (km2) First H5N1 outbreak First human death.htm) Sector 1: 9.817. The poultry population in Indonesia comprises: broilers: 919. Pekalongan.http://www. The overall broiler population in 2007 is estimated at 889 million birds.who.905.1 million. No data is available on the poultry industry within the livestock Central Java (Ministry of Agriculture quoted in Jakarta Post 26/1/04). 69% are estimated to be broilers. The contribution of the livestock sector to agricultural GDP in 2006 was 2. Out of the total poultry population.html) 1. (USDA Indonesia Poultry And Products Poultry Annual 2007 quoted at http://www. layers: 85. Outbreaks ongoing at December 2008.html). 225. None (http://www. ducks: 48.3 million. (Sumiarto and Arifin 2008:9). Thus.fita.pdf) August 2003.worldbank. 113 deaths to 12/12/2008 (WHO http://www. 106 million layers. numbers to date Numbers of poultry Note: difference sources give different estimates.worldbank.7m: Sector 2: 58.29m (Rushton et al 2005:5 citing data from CASERED 2004) US$432.39m: Sector 4: 175m.000 (2007. indigenous poultry: 87.pdf) 1.worldbank.7 million.1 million (FAO EMPRES Transboundary Animal Diseases Bulletin 25) 3.fao.pdf) The agriculture sector contributes 14% to the country’s GDP and employs nearly 40% of the active population (January 2008. WDI (Sumiarto and Arifin 2008:6).thepoultrysite. Total 275. According to livestock statistics from 2007. WDI 21% native chicken. 59 Poultry export value Structure of industry (FAO Sectors 14) National GDP Agriculture as % of GDP (poultry industry as % of agric GDP) . 175 million broilers and around 35 million ducks.2m: Sector 3: 32. more than 620 million chicken and ducks are estimated to be the standing population of the country. First confirmed death .

Indonesia received US$2. health. Indonesia’s system of government is both presidential and parliamentary in style. public works and the environment. and displays strong tendencies towards political compromise. There have also been extensive public service announcements relating to avian influenza on television. The 2005 figure represents 0.worldbank. Despite some bright spots. the civil service is broadly seen as inefficient and ineffective. Dengue is widely perceived as more dangerous.earthquake in Papua.floods in Jakarta. Avian influenza is seen as one of several lethal poultry diseases which hit poor small-holders particularly. This compares with US$ bomb in Jakarta. Since 2001 the country has seen farreaching decentralization. Now highly decentralized. October . The threat to humans is only one of a number challenges to the health system. Efforts are being made to counter the ‘corruption.mudflow in East Java.524.earthquake off Sumatra.000 net official development assistance. 2005: March . following reports of avian influenza outbreaks. December . July . 2006: April . or US$11 per capita. February . 2007: January . May earthquake near Yogyakarta in central Java. perceptions Major hazards/disasters since 2004 Framing of risk/uncertainty in policy Social constructions of risk and uncertainty by public Media coverage of avian influenza Politics.9% of Gross National Income. or human deaths. and significant regional autonomy.passenger aircraft crash in Medan. uncertainty. Now 456 autonomous local governments are responsible for major sectors such as education. culture.Aid dependency (% GDP) Risk. There is very little understanding of the idea of a human influenza pandemic. as well as raising revenue. cronyism and nepotism’ of the past. Historically authoritarian and top-down.earthquake off Java.000 in December . October .pdf) 2004: February . 60 .ferry sinks in Java Sea. October . Indonesia is a republic which has seen significant decentralization since 2001. (WDI http://siteresources. but some commentators suggest a high degree of continuity exists between the new democratic politics and those of the authoritarian past. governance and political culture Styles of decision-making in bureaucracy Patronage politics and influence on policy Form of democracy – role of civil society State structure – level of decentralization Regulatory cultures/styles In 2005. Indonesia is a numinous society.suicide bombings on Bali. Parliamentary democracy with a directly elected president. Protests and demonstrations by civil society are frequent and widespread. Poultry consumption falls temporarily.passenger aircraft crash off Sulawesi. Indonesia suffers regular natural and man-made disasters. and behaviour changes temporarily. Avian influenza is widely reported in the press on television news.Indian Ocean tsunami.654.

Vision International . and PT. Capacity building. AusAID (also the governments of Germany. production capacity. or anti-viral drug. with national co-ordination provided by the Komiti Nasional Pengendalian Flu Burung dan Kesiapsiagaan Menghadapi Pendemi Influenza (KOMNAS FBPI).HPAI response Major donors/international agencies involved in avian influenza (rank?) NGOs. Restructuring the poultry industry. civil society groups involved Key interventions for HPAI control and response Areas of government responsible – coordination Vaccine/drug manufacturing capacity Major donors include: USAID. 3. a collaboration between Bogor Agricultural University (IPB) and SHIGETA Animal Pharmaceuticals Inc. World Bank. the Ministry of Agriculture (MoA) and Departemen Kesehatan (Depkes). 4. the Ministry of Health (MoH) are primarily involved. or have been. Forestry. The Indonesian Red Cross (International Federation of Red Cross and Red Crescent Societies) and Muhammadiyah (a faith-based organization) are significantly involved. involved in smaller projects. Departemen Pertanian (Deptan). Japan and the Netherlands). CARE. UNOCHA and UNICEF. Monitoring and evaluation. as they were considered to impact more rapidly on the spread of the virus and thereby reduce the number of human cases. Japan. the police chief. No human vaccine. Control in animals. Vaksindo. 2. 61 . and the chairman of the Indonesian Red Cross. Many other national and international NGOs – such as Save the Children. 5. 9. have smaller capacities. IPB Shigeta Animal Pharmaceuticals. including the Agriculture. and 6. The January 2006 National Strategic Plan for Avian Influenza Control and Pandemic Preparedness outlines ten strategies based on principles advocated by the FAO. 4. Risk communication. National Planning (Bappenas) and Industry ministers. UN WHO. 10. Strengthening relevant laws. the National Committee for Avian Influenza Control and Pandemic Influenza Preparedness. Health. which has 14 members. Medion in Bandung has significant poultry vaccine production capacity. Bilateral support includes that from US Department of Agriculture Foreign Agricultural Service. PT. 6. Epidemiological surveillance for animals and humans. information and public awareness.. Action research. and PT. 7. the WHO and the World Organization for Animal Health (OIE): 1. In August 2006 a decision was made to prioritize strategies 1. International implementing agencies include UN FAO. 8. This is a ministerial-level committee. headed by the Coordinating Minister for People's Welfare. Protection of high-risk groups. Management of human cases.are. the Economics coordinating minister. the army commander.

Background Paper Africa/Indonesia Team Working Paper No. 3 available at http://www. Indonesia..References CASERED (Indonesian Centre of Agricultural Socio-Economic Research and Development) (2004) ‘Socio-Economic Impact Assessment of the Avian Influenza Crisis in Poultry Production Systems in Indonesia. Thailand. (2005) ‘Impact of avian influenza outbreaks in the poultry sectors of five South East Asian countries (Cambodia.fao. and McLeod A. responses and potential long term control’.. Bleich E. (2008) ‘Overview on Poultry Sector and HPAI Situation for Indonesia with Special Emphasis on the Island of Java’.info/PDF/Outputs/HPAI/wp03_IFPRI. and Arifin B.research4development. Report for FAO’s TCP/RAS/3010 available at http://www. Viscarra R.pdf accessed 12 December 2008 62 . Viet Nam) outbreak costs.pdf accessed 12 December 2008 Sumiarto B.G. Final Report for FAO’s TCP/RAS/3010 ‘Emergency Regional Support for Post Avian Influenza Rehabilitation’ Rushton J. with Particular Focus on Independent Smallholders’.org/docs/eims/upload//214194/poultrysector_seasia_en. Lao PDR.

Dwi Suryanto. Philipus Sembiring. and Rosdanelli Hasibuan (OSRO/INT/501/NET).000 Source: 'Poultry Market Chain Study in North Sumatra' by Albiner Siagian. medicines. Rasmaliah. Zulfikar Siregar. equipments) Coordination No Coordination ◘    Closed truck with boxes Opened truck with cages Opened truck with egg trays Plastic boxes 1 M = 1.APPENDIX C: LAYER MARKET CHAIN IN NORTH SUMATRA.000. Ma'ruf Tafsin. Nevy Diana Hanafi. Live Birds Carcass Eggs Others (feed. FAO (undated) Page 16 63 .

APPENDIX D: ROAD MAP OF KAMPONG CHICKENS IN BALI Road map of kampong chickens in Bali. Source: 'Poultry Market Chain Study in Bali' by Made Mastika (OSRO/RAS/602/JPN) FAO (undated) Figure 4 Tejakula Kubutambahan Grokgak Kintamani Kubu Seririt Melay a Mendoyo Pekutata n Busungbi u Pupuan Sukasada Petan g Susut Abang Bajr a Peneb el Marga Manggis Seray a JAVA Payangan Kerambitan Kediri Candidasa Mengwi Banjarangkan Note: : Kampong Chickens : Sub district distribution Nusa Penida 64 .


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